CPhA’s Negotiated Suspension of Medi-Cal Clawback to Stay in Place!
As previously reported, CPhA filed a request for a Temporary Restraining Order against the California Department of Health Care Services (DHCS) to in order to continue the suspension of the clawbacks on pharmacies who serve Medi-Cal patients. The original suspension was negotiated by CPhA Counsel and lawyers for the respondents last summer. Toward the end of last year, DHCS announced that it intended to resume the clawbacks in February of 2020.
The judge assigned to our case, Judge Jeffrey White of the U.S. District Court, issued an immediate directive to the DCHS as a result of our TRO request, suggesting that the Department agree to continued voluntary suspension of its clawback efforts until the Court rules on the original preliminary injunction request.
Additionally, the Judge ordered the State to address the impact of the pendency of CPhA co-sponsored, AB 2100 (Wood) on the litigation. This was key to our efforts!
CPhA is pleased to announce that this morning the State agreed to the Judge’s request so the clawback suspension will remain in place indefinitely until further order of the Court.
CPhA will continue to fight for pharmacists providing care to our state’s most vulnerable residents.
Contact: Michelle Rivas, Vice President Center for Advocacy email@example.com.
Community Pharmacists throughout California have united to form Californians for Access to Life-Saving Medicine: a coalition of the Community Pharmacy Advocacy Group (CPAG). The purpose of CPAG is to help save your community pharmacy and preserve patients’ rights to come to your practice.
Consumer access to independent community pharmacies is at grave risk. Multiple factors by outside entities such as Medi-Cal program cuts and PBMs continue to erode the viability for independent pharmacies to survive.
Many community pharmacies have already experienced the recent reductions to Medi-Cal reimbursements under the new NADAC payment system. On May 31, 2019 a bureaucratic state decision made by former Governor Brown’s Administration became effective that denies life-saving medicines to Medi-Cal patients. Since implementation, it prevents community pharmacies from being able to provide vital medicines for California’s most vulnerable populations.
So how did we get here? In the summer of 2016, the federal Centers for Medicare and Medicaid Services adopted a rule to change how pharmacies are paid for dispensing prescription medicines. CMS is requiring every state to adopt new rules to conform with the federal standard but did not say how states should do this.
The new methodology developed by the California Department of Health Care Services will result in denying life-saving medicines for Medi-Cal patients. In fact, it has already started resulting in catastrophic reductions to Medi-Cal reimbursement rates for hundreds of locally owned pharmacies that serve Medi-Cal patients.
And what’s worse, is that it is not JUST forward-looking cuts. DHCS announced it is collecting two years of retroactive payments from community pharmacies that currently serve Medi-Cal patients, dating back to April 2017.
What does this mean? About 3 million medically fragile beneficiaries stand to lose access to their essential, life-saving medicines. Particularly those patients with:
- Behavioral health challenges
- Seniors and adults with disabilities living in long-term care facilities.
The new state rules will bankrupt many community pharmacies, effectively eliminating this important health care safety net for California’s most vulnerable populations.
California CAN and MUST do better.
The State of California’s practice to discriminate against patients and pharmacies is why Community Pharmacists statewide are fighting back against the state and standing up for Medi-Cal patients, their right to life-saving medicines and for all community pharmacists.
In addition, CPAG is taking on Pharmacy Benefit Managers (PBMs) who continue to negatively impact owner’s viability as an independent community pharmacy. It seems as if each year they develop creative new ways to financially penalize taking care of your patients. Whether it is DIR fees, GER, or insultingly low professional service dispensing fees, there seems to be no end to what PBMs will do to threaten independent community pharmacies.
CPhA was proud to work with Assemblymember Wood on the signing of AB 315 last year. For the first time, PBMs are now regulated by the Department of Managed Health Care (DMHC) in California. The implementation of this legislation will take some time as the agency rolls out the rule-making process. But in the meantime, PBMs continue to extract millions of dollars from independent community pharmacies. AB 315 was a huge victory, but we know that more needs to be done.
CPAG’s first priority is to address the DHCS’ clawback that began on May 31, 2019. Next we are challenging the flawed methodology that led DHCS to adopt the NADAC proposal for specialty medicines in the first place. Finally, we are mounting an aggressive legislative and public affairs campaign to shine more light on PBM practices and eliminate harmful policies, such as DIR fees, from being implemented in California.
Part of the public relations efforts to outline the negative impacts that PBMs have on the viability of community pharmacies. One strategy is to provide a video testimonial that will be used in advocacy and media outreach efforts. If you are willing to share your story, please email Nick Chiappe at firstname.lastname@example.org and we will add you name to the list of interview candidates.
In order to successfully build out this aggressive plan, we need resources to fight back.
We are asking pharmacy owners and friends of pharmacy to make a contribution to Californians for Access to Life-Saving Medicine, a coalition of the Community Pharmacy Advocacy Group. These contributions are reserved for these independent owner issues only, and are necessary to hire the best and brightest attorneys and public relations firm. Can we count on your support and contribution for the Community Pharmacy Advocacy Group fund? To contribute, click here.
Please email email@example.com.
The coalition is led by a group of independent, community pharmacists:
Amy Nguyen, Pharm.D., MBA
Eddie Gozini, Pharm.D.
Jack Vasoya, R. Ph.
Express Pharmacy, Pomona, CA
Jae Suh, Pharm.D.
Katie Bass, Pharm.D.
San Joaquin Drug Corporation
Ken Thai, Pharm.D.
986 Degrees Corporation
Kevin Komoto, Pharm.D., MBA
Liz Altmiller, PharmD
Your Drug Store, Bakersfield, CA
Micah Hata, Pharm.D.
Western University of Health Sciences
Mohammad Etminan, R.Ph., MS
Total Remedy and Prescription Center
Raja Sannidhi, Pharm.D.
Tamir Wertheim, Pharm.D., MBA
West Knoll Pharmacy
Advantage Healthcare Services
Thank you to all the 130+ pharmacies who have agreed to submit a declaration. The attorneys are working through the list of community pharmacy owners to assist in the suit. Please wait for further instructions.
CPhA’s Legislative Day will be in March. Stay tuned for a specific date!