Local pharmacists urging lawmakers to eliminate ‘the middle man’

Some Kentucky pharmacists say they’re being cheated after slumping medicaid reimbursements

Kentucky pharmacies urging lawmakers to cut out PBMs

McLean Co., KY. (WFIE) - Take out the middle man. That is the message local pharmacies in Kentucky are urging legislators in the Commonwealth.

Some Kentucky pharmacists say they’re being cheated after slumping medicaid reimbursements. Owner of Sacramento Pharmacy Dr. Gregg Henry is one of them.

In a town of less than 400 in rural western Kentucky, a bulk of Dr. Henry’s customers are on medicaid.

“Over half of our prescriptions are Medicaid prescriptions,” he said.

The pharmacist told us his medicaid reimbursements fell sharply and have been low for some time now. He recently made a stop in Frankfort to lobby against what he says is criminal activity.

In Kentucky, CVS Caremark, one of the nation’s largest pharmacy benefits managers, or PBM for short, processes the vast majority of medicaid claims in Kentucky.

Dr. Henry believes the PBM is stealing from him by not reimbursing his pharmacy enough.

During a meeting open to the public at Sacramento Elementary gym on Thursday, Dr. Henry told listeners he now has the numbers to prove it.

“The insurance company paid $394 and some change for those 5 prescriptions," Dr. Henry gave a recent example to the crowd. “We got a total of $84. The PBM kept 80% of the money the insurance company gave them, to give to us, fact,” he asserted.

Dr. Henry claims CVS cut its reimbursements by 50% without state approval, which makes it against the new Kentucky law, known as Senate Bill 5 passed in 2018.

“SB 5 passed unanimously, the governor signed it into law," Dr. Henry said. "These thieves broke the law, and then we found out, we’re better off without them anyway.”

He’s not the only one who feels this way.

Pharmacists from Owensboro and other towns also attended the meeting Thursday.

The group signed a petition with the goal to get thousands of signatures. They’re asking for state legislators to follow in West Virginia’s grassroots movement to eliminate the middle man, which has saved the state tens of millions.

The group says they plan to bring that petition to the Kentucky governor’s desk after the election.

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