Listen up if you process Medicaid prescriptions! The hard-won Medicaid pharmacy dispensing fee increase from $5.14 to $7.50 could be lost by September.

Contact your U.S. representative NOW to urge him or her to join with Congressman Ralph Hall (R-TX) and Congressman Lloyd Doggett (D-TX) to sign a letter to CMS requesting immediate approval of the Texas Medicaid state plan amendment.

Click here to find your U.S. Congressional district, your representative's name, and his or her Washington, DC, phone number.

Call ASAP! The goal is to get all the signatures before close of business Friday, July 31.

Talking Points

In August 2007, the Texas Medicaid Vendor Drug Program submitted a state plan amendment (SPA) to the Centers for Medicare & Medicaid Services (CMS) to comply with a legislative directive to increase the pharmacy dispensing fee for Medicaid prescriptions, revising the "fixed component" of the rate calculation from $5.14 to $7.50 per prescription.
To date CMS has yet to make a decision on the proposed increase in dispensing fee. Notably, the state has been reimbursing pharmacies at the $7.50 "fixed component" rate since enactment of the 2007 state law directing the dispensing fee increase. Since the SPA has not been approved, Texas has used only state funds, with no federal matching dollars, to fund the increase. This has caused the state of Texas to incur costs of over $52 million.
Due to the current Texas budget situation and lack of SPA approval by CMS, Texas Medicaid will no longer be able to pay at this rate without receiving the Federal Medical Assistance Percentage (FMAP) matching funds. As a result, Texas Medicaid may be forced to reduce payment to pharmacies to the previous inadequate rate of $5.14 starting September 2009 or to revise the reimbursement methodology in a manner that would be detrimental to protecting access to pharmacy services for Medicaid beneficiaries.
Any such reduction in the dispensing fee is significant when one takes into account Texas Medicaid's aggressive reimbursement approach wherein pharmacies are reimbursed for drug products using actual acquisition cost.
The previous Texas Medicaid dispensing fee was well below the average cost that a pharmacy incurred dispensing a Medicaid prescription. The University of Texas at Austin College of Pharmacy, Center for Pharmacoeconomics, in conjunction with the McCombs School of Business conducted a study commissioned by the Texas Health and Human Services Commission indicating that the average cost to dispense a Medicaid prescription in Texas in 2007 was $9.41. Approval of the pending SPA to remedy this disparity is imperative to ensure that pharmacies are adequately reimbursed so that beneficiary access to critical pharmacy services can be maintained.

CORRECTED LINK: Click here to see the DRAFT letter.

After you contact one of the congressmen, click here to report your call or e-mail. Not only do we want to know how many contacts are being made, we want to include you in our list of "Phlashers" who make such a difference in our legislative success.

Stay tuned!