Senate bill could change Medicaid prescriptions are paid

Senate bill could change Medicaid prescriptions are paid
(WFIE)

SACRAMENTO, KY (WFIE) - The battle between local independent pharmacies and corporate giants continues.

One western Kentucky pharmacy owner says Medicaid reimbursements have declined sharply. He says it's really putting a squeeze on the smaller drug stores.

Senate Bill 5 could change that. It all boils down to how Medicaid prescriptions are paid. SB-5 would, in part, require the Department of Medicaid services to directly administer all outpatient pharmacy benefits.

Along Main Street, Dr. Gregg Henry has owned the Sacramento Pharmacy for more than five years.

"We'll do 125-150 prescriptions a day," Dr. Henry calculated.

In a town of fewer than 400 people, he says he sees 50 to 60 customers daily.

"Over half of our prescriptions are Medicaid prescriptions," Dr. Henry stated.

But, recently, he notes a sharp decline in Medicaid reimbursements.

In Kentucky, CVS Caremark, one of the nation's largest pharmacy benefits managers, processes the vast majority of Medicaid claims.

"The problem with that, for me, is they were the reason for the reduced reimbursement because they own the insurance company that reimburses us or PBM, pharmacy benefit manager," Dr. Henry explained.

SB-5, which has passed through a Senate committee, partly requires the department for Medicaid services to directly administer all outpatient pharmacy benefits.

"If it's a flat rate, I'm fine with that," Dr. Henry said.

Dr. Henry told us he was even met by letter.

"Wanted to know if we'd be interested in selling to them," Dr. Henry recalled.

But, he seems skeptical of their intentions and says he isn't going down without a fight.

"Really don't think they're interested in putting a nice, new pharmacy right here in Sacramento. They just want to get rid of me and everybody like me," Dr. Henry described.

A fiscal note attached to the bill says it'll cost the state $36 million if PBMs are taken out.

However, Henry says an independent study showed it could actually save Kentucky $348 million.

Copyright 2018 WFIE. All rights reserved.