“How did it get so late so soon? It's night before it's afternoon.” - Dr. Seuss
DSHS figures indicate that, of those 900,000 folks, not quite 200,000 are either elderly or low-income disabled people. Those figures also show that fully 50 percent of the remaining patients on Medicaid in Washington are children living within or near federal poverty-line standards.
Starting Aug. 1, due to recent action by the state Legislature in Olympia, approximately $22 million in state revenue was cut from the state’s Medicaid program, which directly affects reimbursement payments to pharmacies. The slash in Medicaid funding was one of many budget cuts by the Legislature to offset a shortfall in revenue.
Already, in certain rural counties, some Medicaid patients are not getting their prescriptions filled, according to Jim Stevenson, Washington Medicaid communications director.
One three-store, Seattle-based firm has “opted out,” of the Medicaid reimbursement program according to the Washington State Pharmacy Association (WSPA), headquartered in Renton, although the association would not name the firm.
Also no longer filling Medicaid prescriptions, according to the WSPA, are multiple-store, single-owner groups in Renton and Yakima.
Several elderly Queen Anne residents who don’t wish to be identified said that, although they are still getting their prescriptions filled, they fear there will come a day when their prescriptions will be refused.
Spokespersons for the bigger area pharmacies, including Bartell Drugs, told the daily metro newspapers they are still filling Medicaid prescriptions. But no one is saying how long that policy will continue.
The WSPA said they negotiated most of this summer with state officials, but neither side reached an agreement on the pending cuts.
It’s a touchy situation and a potential public relations nightmare for area pharmacies.
Calls to Virginia Mason’s Medicaid billing department resulted in an employee hanging up as soon as this reporter identified himself.
But a return call was received from Richard Paul, a Virginia Mason manager.
“We have not changed our policies at this time, but we are having meetings to address the issue. We are looking at reimbursement issues. Making sure we are not losing money [filling Medicaid prescriptions],” Paul said.
“There are some prescriptions [under the state's new guidelines] where we are losing money filling them,” Paul said.
Paul didn’t wish to comment on the record on whether he thought the elderly and the disabled were caught in the middle of a battle between state officials and pharmacies.
Last year, Stevenson said, the Federal Office of the Inspector General, the federal agency that oversees Medicaid, studied eight states, including Washington. They studies all kinds of stores: small, large, independent and chains and concluded that Washington state was paying too much to pharmacists for drugs.
Stevenson said that drug companies set an average wholesale price for drugs in a similar fashion as a sticker price on new cars. But, Stevenson said, as with cars, everybody pays less than the sticker price.
The AWP, average wholesale price, was discounted in Washington state to 80 percent, meaning that Washington’s Medicaid program reimbursed pharmacists 89 cents on every dollar. The feds recommended paying 80 cents; the state compromised at 86 cents per dollar on the AWP, which is what the pharmacists are resisting.
“Medicaid was one of the better [paying] programs for pharmacists. They [the pharmacists] were in general receiving less from private [medical insurance] industry than from Medicaid. So this was a painful cut, but they [the pharmacists] have already accepted some deeper cuts from private insurance providers,” Stevenson said.
The projected budget savings from these cuts will be $21.7 million annually, according to Stevenson.
Doug Porter, an assistant secretary of the state’s Medical Assistant Administration, a Department of Social Health and Services division, attended public meetings before the cuts were officially implemented earlier this month.
“I was much impressed with the vulnerability expressed,” Porter said in a report published by the DSHS itself.
“People are afraid of losing their benefits in hard times, and they are worried the state will be unable or unwilling to fulfill the commitment it has made over the [previous] years,” Porter said.
Recently, in Okanogan, Pacific and San Juan counties, Medicaid patients who were refused prescriptions were driven to other locations by DSHS employees to fill their medicine needs, according to Medicaid’s Jim Stevenson.
“There are a few rural sections of the state where there is only one pharmacy for 100 miles. We have helped people in those areas get their prescriptions filled ….We’re braced for more people in those areas needing help [filling scrips if solo pharmacies withdraw from Medicaid]. But we do not expect any difficulties in the Seattle area. Only two pharmacies in King County have stopped [filling Medicaid] prescriptions,” Stevenson said.
Freelance writer Dennis Wilken is a Queen Anne resident.