Managed Medicaid hurts independent pharmacies

August 12, 2013 

  • At issue: Aug. 1 news article by Valarie Honeycutt Spears, "Audit raises concerns about Medicaid in Kentucky"

By Rosemary C. Smith

Independent pharmacies across the state are in complete agreement with the sentiments expressed by state Auditor Adam Edelen. Like rural hospitals, independent pharmacies and our patients continue to struggle 21 months after the implementation of Medicaid managed care.

Having served Medicaid patients in rural Eastern Kentucky for more than 40 years, my husband, Luther, and I joined more than 500 others to form the Kentucky Independent Pharmacist Alliance as a way to be a voice for our patients, our employees and the communities that depend on our professional service.

Independent pharmacies continue to experience the following critical issues with the managed care program:

■ Managed care organizations are often not paying pharmacies on time in accord with state law. Some payments are still outstanding from services provided shortly after the Nov. 1, 2011, implementation date.

■ Frequently, reimbursement to the pharmacies is less than the drug's cost to them.

■ Transparency is lacking with respect to below-cost reimbursement in which the managed care companies refuse to correct their pricing structure or provide pharmacies with information needed to obtain a drug at the reimbursed price, even though a law that took effect July 1 should have provided relief.

Independent pharmacies agree with Edelen that managed care has to be a fair deal for providers, members and taxpayers. A number of independent pharmacies have been forced to close due to the financial strains that have come with managed care. Edelen is right on point to worry about access to health care for all rural Kentuckians.

At issue: Aug. 1 news article by Valarie Honeycutt Spears, "Audit raises concerns about Medicaid in Kentucky"

Rosemary C. Smith of Beattyville is a registered pharmacist; co-founder and secretary-treasurer of the Kentucky Independent Pharmacist Alliance; and an owner of Jordan Drug Inc., a 40-year-old independent chain serving six Eastern Kentucky counties.

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