May 16 – Legislators are working on a bill that could help independent pharmacies receive proper reimbursement for filling Illinois Medicaid patients’ prescriptions.
Dale Colee, owner of Dale’s Southlake Pharmacy and Colee’s Corner Drugs, said HB3479 would require the Illinois Medicaid Managed Care Organizations to pay all pharmacies the same amount for prescriptions. “The PBM [Pharmacy Benefits Manager] is paying certain pharmacies – ones they are actually involved with – a higher rate than they are the independent pharmacies. This bill would require the reimbursement rate for the medication to not be below our acquisition cost and would be the same as what everyone else is getting reimbursed at this point.” He continued to say it costs around ten dollars to fill and process prescriptions and they are “not getting near that for close to 70 percent of those prescriptions.”
The bill has been passed by the House and is now awaiting approval by the Senate. Local State Representatives Sue Scherer and Bill Mitchell are co-sponsors of the bill and Senator Andy Manar is Chief Senate Sponsor. The Senate has a deadline of May 31, 2018 to pass the bill. Colee said if they do not approve the bill, it could have negative consequences for independent pharmacies. “If it doesn’t get passed, you are going to see a lot of independent and smaller pharmacies go to the wayside, especially if they are in an environment where they have a lot of public aid and managed care business.” Colee said he has a store within Crossing Healthcare that would be heavily affected because of the high volume of Medicaid patients.
This issue is not specific to Illinois. Colee mentioned there have been many pharmacies across the country, including Ohio and Arkansas, and the rate has caused independent pharmacy numbers to dwindle. “I’ve talked to a lot of the independent pharmacies and they are all in the same boat. There is a guy I know in the Staunton area where if he doesn’t get some sort of help in getting this turned around, he could lose his store.” Colee said when he started his business in Decatur 40 years ago, there were 18 independent pharmacies and two box stores in Decatur and now his store is the only independent pharmacy in Decatur and Sav-Mor helps to serve the residents of Mt. Zion.
Colee said independent pharmacies are part of the fabric of their communities by employing local people who spend their wages locally and make local donations. He said other stores differ from them because they earn their money in town and then spend the money elsewhere. “You do not see a lot of those organizations really going out and helping the community. You don’t see them doing a lot of donations and a lot of things within the framework of the community. That’s a major part of it. We are a part of the community. We live here and that’s what sets us apart from the big box stores.”