Pharmacists Fight for Reimbursement Rates

KNWA

Some pharmacies across the state are losing money due to what they consider to be a lack of regulation between insurance providers and drug manufacturers. 

Arkansas governor Asa Hutchinson called a special session of the Arkansas legislature to address the concern of low reimbursement rates to pharmacies.  

One local pharmacist says the special session is giving a voice to the smaller independently owned pharmacies. 

“It’s been a growing irritation,” Dr. Jim Graham from Cornerstone Pharmacy. 

Dr. Jim Graham owner of Cornerstone Pharmacy in Bella Vista says he’s seeing a misuse of money within his prescription claiming process. 

When he submits an order for medication –  a middle man called a pharmacy benefits manager or PBM – processes the claim with the pharmacy’s insurance.

The PBM then reimburses Dr. Graham.

“In December, I filled a patient’s prescription, a very expensive migrane medicine. I got payed 467 dollars for that drug.”

In the last couple of months, Graham’s says things changed- the PBM is not giving him enough money back. 

“In January, my payment then dropped to 121 dollars,” Dr. Graham said. “I lost 245 dollars plus my expenses.”

Graham had to make a choice – fill the prescription or lose a customer. 

“We take care of our patients, so i took this filled prescription as a loss.”

The special legislative session is set to discuss this issue – following controversy involving CVS Caremark, the PBM for Blue Cross Blue Shield, the state’s largest insurance provider. 

Due to the 2017 increase in health care costs across the state, Arkansas Blue Cross asked the legislature for an increase in insurance rates – causing a chain reaction affecting pharmacists. 

“So we told the insurance companies you cannot have a twenty percent increase, you can only have half of that,” Arkansas State Representative Charlie Collins said. 

The Arkansas Pharmacists Association found CVS Caremark pays itself around 60 dollars per prescription more than it pays pharmacies.

“They are finding ways to manage the program without increasing the costs to make everyone happy,” Representative Collins said.

Arkansas Representative Charlie Collins says regulations of the PBMs would have a large impact on Arkansans.

“What help means is more money?” Representative Collins said. “Well where does the money come from? Taxes from our taxpayers or cut it from somewhere else. So if you then cut it for schools and then the teachers wouldn’t be very happy and so on.” 

Without change to the regulations, Graham says he may have to close his doors. 

“We want a fair level playing field,” Dr. Graham said. “I want to compete with the big boys and beat them just by service.”

We reached out to Blue Cross Blue Shield and CVS Caremark and have not heard a response back yet. 

The special session will begin after the ongoing fiscal session.

The governor did not give an exact date.  

Copyright 2019 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Trending Stories

Don't Miss

More Don't Miss