Below-cost Rxs: One state just says no
It happens everyday at pharmacies: A patient arrives with a prescription. The drug is in stock. However, the reimbursement the patient’s insurance pays for filling the prescription is less than what it cost the pharmacy to acquire the drug.
Usually, the pharmacy has no choice but to take the loss, as the pharmacy benefits manager (PBM) or the patient’s insurer dictates reimbursements as part of the privilege of the pharmacy being in its network. Other times, the pharmacy does not even know what it will be reimbursed until after the claim is processed.
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Starting in July, a new law in Mississippi will allow a pharmacy to refuse to provide drugs or services if it is not paid more than acquisition cost. Sponsored by Sam Mims (R-McComb), Mississippi Gov. Phil Bryant recently signed the bill into law.
If a pharmacy declines to dispense a drug, the pharmacy must provide the customer with information on where their prescription can be filled.
Supporters of the law, especially independent pharmacists, believe it will help them stay in business. But the nation’s largest pharmacy benefit manager, Express Scripts, said the law reduces patient care and access.
“It is unfair for pharmacies to put profits ahead of people and turn away patients who need medication. The burden should not fall to the patient or payer if a pharmacy is not a good purchaser of drugs,” Brian Henry, an Express Scripts’ spokesperson, told Drug Topics.