The look of things to come under Obamacare:
Bartell to stop filling Medicaid prescriptions at some locations
By Maureen O'Hagan
Seattle Times staff reporter
In yet another fight between the state and pharmacies, Bartell Drugs announced Thursday it would discontinue filling Medicaid prescriptions at 15 of its 57 stores on Feb. 1, saying it simply can't afford to do so.
The announcement comes three months after a group of Washington pharmacies and trade associations filed suit in federal court claiming they're not reimbursed enough for Medicaid prescriptions. That lawsuit — the second filed here in the past 10 months on pharmacy reimbursement rates — is pending.
Bartell, meanwhile, said the company will consider shutting down Medicaid business at other stores.
The company's decision is related to a court settlement in Massachusetts that has had a ripple effect around the country.
The amount private insurers and Medicaid pay pharmacies for prescriptions isn't the actual cost of those drugs. Instead, the rates often are based on what's called the drug's estimated average wholesale price.
But that figure is more like the sticker price on a car than the actual wholesale cost of those drugs. Washington reimbursed pharmacies the actual wholesale price minus 14 percent until July, when it began reducing reimbursements to 16 percent.
Pharmacies weren't happy about that. Then, in September, came another blow. The adjusted wholesale price is calculated by a private company, which was accused in a Massachusetts lawsuit of fraudulently inflating its figures. The company did not admit wrongdoing but agreed to ratchet its figures down by about 4 percent. That agreement took effect in September.
Bartell Chairman and CEO George D. Bartell said that most private insurers adjusted their rates to "make us whole," after the ratcheting down. The state, however, didn't follow suit.
"We're losing money on this," Bartell said, so the company decided it simply had to stop accepting Medicaid at some pharmacies.
"This is not the kind of thing we like to do," he added. "This was not anything about the people on the plan. It's about the state."
So far, Bartell is the only pharmacy chain to take this action.
Doug Porter, the state's director of Medicaid, said Medicaid recipients should not worry about other companies following suit. "I'm convinced pharmacies can weather this change," he said.
Medicaid recipients who fill their prescriptions at any of the 15 Bartell stores "will be directed to the next closest pharmacy," Porter said. "My guess is it won't be another Bartell's store."
Meanwhile, several pharmacies and industry trade groups filed suit in U.S. District Court in Seattle trying to force the state to return its reimbursement rates to those it was paying before the Massachusetts settlement. A hearing is scheduled for Jan. 15.
Last year, the pharmacy groups filed another lawsuit, after an earlier attempt by the state to cut its reimbursement rates. That suit was withdrawn when the state agreed to make smaller cuts than it had planned.
The 15 Bartell stores are: Ballard, Roosevelt, University Village, Magnolia, Admiral Way, Bellevue Village, Bridle Trails, Houghton, Inglewood, Bella Bottega, Redmond Town Center, Sammamish Plateau, Edmonds, Mountlake Terrace and Seattle Hill Road. |
