Access to Life Saving Medicine

A Public Health Crisis is Looming

WHAT'S AT STAKE

Healthcare does not exist without access to medicines

The Department of Health Care Services’ (DHCS) decision to implement new Medi-Cal reimbursement rules, adopted by the Brown Administration, and pursue two years of retroactive payments on Medi-Cal claims, will result in denying life-saving medicines for Medi-Cal patients, resulting in catastrophic reductions to Medi-Cal reimbursement rates for hundreds of locally owned pharmacies that serve Medi-Cal patients.  DHCS announced it is collecting two years of retroactive payments from community pharmacies that current serve Medi-Cal patients, dating back to April 2017.

Fair Medi-Cal reimbursement rates can be the difference between continued operation and closure for many inner city and rural pharmacies.

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independent pharmacies considering closure

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independent pharmacies considering no longer serving Medi-Cal patients

The Rule, Defined

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1 - Pharmacies purchase medicines at wholesale price.
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2 - Pharmacies furnish medicines to Medi-Cal** patients.
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3 - Pharmacies submit claims to Medi-Cal** for reimbursement
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4 - Medi-Cal** reimburses pharmacies less than the wholesale purchase price.
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5 - Medi-Cal** also collects retroactive difference from the last 2 years through clawback.
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RESULT: Pharmacies close their doors or stop furnishing medicines to patients
HOW DID WE GET HERE?

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 in communities throughout California that serve of Medi-Cal patients.

And what’s worse, is that it is not JUST forward-looking cuts, either.

DHCS announced it is collecting two years of retroactive payments from community pharmacies that currently serve Medi-Cal patients, dating back to April 2017.

The Impact to Californians is Catastrophic

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    3 Million

    Medi-Cal beneficiaries

    stand to lose access to their life-saving medicines for HIV/AIDs, behavioral health and cancer

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    2 Years

    Retroactive payment

    will be collected by DHCS from community pharmacists that currently serve Medi-Cal patients

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    Drastic Loss

    of community pharmacies

    who have historically been the most accessible healthcare provider to Medi-Cal beneficiaries

WHAT'S AT STAKE

Patients at risk with community pharmacy closure

  • 2,233 Independent Community Pharmacies

    are at risk of closing their doors

  • 134,082 HIV Patients

    stand to lose access to their medications

  • 160,920 Cancer Patients

    stand to lose access to their medications

TAKE ACTION

LETS MAKE A CHANGE

Californians MUST do better

Californians for Access to Life-Saving Medicine is asking Governor Gavin Newsom and legislative leaders to suspend implementation of the Brown Administration’s rule to make way for an alternative solution that protects Medi-Cal beneficiaries and the ability of community pharmacies to fill prescriptions.

Together, we can ensure all Californians continue to have access to the medicines they need and stop these rules from going into effect.