Massachusetts Fails to Update Medicaid Reimbursement Rates, Causing Pharmacy Losses

Massachusetts pharmacists say they are losing "countless dollars" filling Medicaid beneficiaries' prescriptions because the state has not updated its reimbursement rates "for months," the Boston Herald reports. The problem originated over one year ago when the state decided to process Medicaid claims on its own "to save money," but failed to implement a system that automatically updates reimbursement rates to correspond with rising drug prices. While the state has manually updated rates for some "commonly prescribed" drugs, rates for other drugs have not been updated in 15 months. Meanwhile, some drug prices have risen by up to 20%, according to Todd Brown, executive secretary for the Massachusetts Independent Pharmacy Association. The association sent a "sharply worded" letter to state officials last week asking the state to call a meeting on the issue. "We urge the Division to act swiftly to resolve this issue and to avoid the threatening of financial disaster in pharmacies and the subsequent disruption of patient care that may result," the letter said. Although state officials have promised to fix the problem and pay pharmacies retroactively, some pharmacists are "skeptical" that they will ever be fully reimbursed due to the "complexity involved in figuring out who has lost how much," Brown said. Pharmacist Thomas Libby predicted that if the problem is not resolved soon, pharmacists will begin turning away Medicaid beneficiaries seeking prescriptions (Powell, Boston Herald, 2/23).