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Impending rule change threatens access to life-saving medicines

A critical safety-net for Californians is at stake. Independent community pharmacies across our state are facing drastic cuts that threaten access to essential life-saving medicines among California’s most vulnerable Medi-Cal beneficiaries – roughly three million people.

Earlier this year, the California Department of Health Care Services adopted a new methodology – approved by former Governor Brown’s administration – to calculate Medi-Cal reimbursement rates for specialty medicines. This new calculation results in a lower reimbursement rate for independent pharmacies. At the same time, DHCS announced they would pursue two years’ worth of retroactive recoupments from these pharmacies.

The result is an annual $67 million cut to Medi-Cal reimbursements, plus an additional $36 million in clawbacks for independent pharmacies.

For dozens of small, inner city and rural pharmacies, fair Medi-Cal reimbursement rates can be the difference between continued operation and closure. A recent survey of independent pharmacists in California found that more than 60 percent are considering closure or are preparing to close as a result of these rules and nearly three-quarters are considering or preparing to stop serving Medi-Cal patients or dispensing specialty medications.

Without these pharmacies, many patients will have nowhere to go.

Particularly at risk are those who need access to specialty medications and services, including people who are battling cancer, HIV/AIDS, behavioral health challenges, and seniors and disabled adults living in long-term care facilities.

That is why we need patients and organizations committed to protecting access to life-saving medicine to join our coalition.

Together, we can work to ensure all Californians continue to have access to the medication they need.