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Pharmacy group sues over state's Medicaid fee cut

July 5, 2011

A non-profit group for local pharmacies statewide is suing the state’s Medicaid office in federal court, attempting to block cuts to the fees given to local pharmacies participating in the Medicaid program.

Community Pharmacies of Indiana and Williams Brothers Healthcare Pharmacy in Southern Indiana filed a lawsuit July 1 in U.S. District Court for the Southern District of Indiana seeking a temporary restraining order and permanent injunction against Indiana Family and Social Services Administration’s Office of Medicaid Policy and Planning. The suit aims to stop the state from imposing a 38 percent cut in the Medicaid pharmacy-dispending fee, which would mean pharmacies would receive $3 instead of $4.90 for preparing and dispensing a particular drug.

If imposed, that cut would be in effect from July 1, 2011 until June 30, 2013, and the CPI says it could result in pharmacies closing. Such closings could put patients at risk who may not have access to their needed medications as a result.

“We don’t feel as though we have any choice,” said Nathan Gabhart, president of CPI that represents about 170 pharmacies statewide. “Litigation is always the last resort, and in this instance, it’s the only option left. We have a very real concern, based on our research, that this cut will force a number of pharmacies in Indiana to drop out of the Medicaid program and jeopardize many Medicaid patients’ access to the vital prescription drugs that they need to stay healthy and in some cases to stay alive.”

On top of this cut, the lawsuit says pharmacies already took a 34 cut on brand name medication reimbursement in September 2009.

The lawsuit alleges the cut violates federal Medicaid law because the state FSSA secretary didn’t approve the fee reduction as required and that also runs contrary to the Supremacy Clause of the U.S. Constitution. The suit also alleges the fee reduction violates Indiana Code 12-15-13-2, which states that Indiana Medicaid providers must offer services to program recipients similar to what the general population might receive.

Since the suit was filed July 1 challenging a cut designed to take effect that day, Judge Tanya Walton Pratt held an emergency hearing to hear initial arguments from both sides. The Attorney General’s Office had just received notice that day, and so the judge gave the state office until 4 p.m. July 6 to file a brief in the case before she decides on the temporary injunction that would halt the new cut.
 

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