Rx for failure


Arthur, Ill (WAND) – Pharmacist Cindi Reed recently filled a prescription for a child which resulted in a loss to her Douglas County drug store of $200.  It likely won’t be the last.

The states new Medicaid managed care system has your neighborhood pharmacist crying foul after continual losses since the program started on April first.  They point to the new program as being a failure and also blame pharmacy benefit managers, PBMs.  PBMs are the middleman between the insurance company and the pharmacist and set the prices pharmacists can charge when filling a prescription.

Reed operates Dick’s Pharmacy in Arthur and a second drug store in Sullivan.  Like other independent pharmacists we have talked to around central Illinois the Medicaid prescriptions are losing money for the drug store, costing customers more money and hurting Illinois taxpayers who are picking up the Medicaid tab.

Reed showed the WAND I-TEAM paperwork on a prescription she fills for penicillin to treat a child with sickle cell.  The prescription takes thirty-to-forty minutes of work to fill and dispense.  Yet, because of the price set by the PBM, she only earns $1.18 above the cost of the drug.  Reed also went through some other cases.

“Under managed care it’s mostly losses and significant losses,” Reed told WAND I-TEAM reporter Doug Wolfe.  “Not just a dollar here, or a dollar there, I mean I took a $200 loss on a prescription for a child.”

PBMs, under contract terms, prevent your pharmacist from saving you money when you have a prescription filled.  They cannot tell you it may be cheaper to pay cash for your prescription instead of using insurance.

“Technically, we cannot, under those contracts, we cannot offer them the cheaper cash price,” Reed stated.  “And we also cannot tell them that we take a loss on their prescriptions.”

Legislation is currently pending in the Illinois General Assembly which would boost reimbursement for pharmacists filling managed care prescriptions.  

HB 3479 has both Democratic and Republican support.

Current Conditions