JONESBORO, AR (KAIT) - Your access to medication in Arkansas may have been put in jeopardy this year.
It all comes down to massive payment cuts in the Arkansas Works Plan, an area pharmacist said Wednesday.
That is part of the state's Medicaid expansion, which could see even more changes.
Gov. Asa Hutchinson has put forth a series of proposals for the program.
Pharmacists say they are keeping a close eye on the program as many of them are fighting to keep their doors open.
Brandon Cooper, a Jonesboro pharmacist, said the payment cuts are the most egregious he's ever seen.
"Many pharmacies are struggling to either fill the prescription and take a loss to take care of their patients or if they just have to turns those people away," Cooper said.
According to Cooper, pharmacies across the state have gone from on average from making about $10.24 a prescription in 2017 to, on average losing $4.26 per prescription, in the first part of 2018.
"We've tried to shoulder the loss that we've had, but on some of them in these Arkansas Works plans, we've either had to inform the patient that we could not fill that particular prescription," Cooper said.
Cooper gave a claim example from the first week of January.
A pharmacy was paid by the Pharmacy Benefit Managers (unregulated middlemen who are artificially driving up the cost of healthcare, according to Cooper) $25 for generic Phenergan suppositories, which was a $590 loss to the pharmacist.
He said the PBM then charged the Health Plan $869.06 for the same prescription.
"PBM spread is significant because the incentive is to pay the pharmacy as little as possible and to charge the Health Plan as much as they can," according to Cooper.
The cuts have affected both chains and independent pharmacies.
The chaos left behind has forced some pharmacies, especially ones in rural areas, to face the decision to lay off employees, cut costs in other ways and some contemplating on closing their doors.
"We've heard of many instances in Northeast Arkansas, which these patients are already financially underserved, a lot of them walk to their local pharmacies," he said. "If that pharmacy is unable to fill that prescription, that person really has no choice other than try to walk to the nearest pharmacy or sometimes travel as much as 30 minutes out of the way to get their prescription field."
A law was passed in Arkansas that states these insurance plans have to pay the pharmacy at least what the medication costs, according to Cooper.
"Their failure to do so now violates state law," he said. "So, a pharmacy can, in fact, refuse to fill that prescription if they don't want to shoulder that loss. A lot of legislators have invested in this because they are the ones that helped pass legislation to help deal with these problems. Now if that law isn't being followed, they are trying to take corrective action to try to enforce those laws and hold these insurance companies accountable."
Region 8 News spoke with District 52 State Rep. Dwight Tosh, who has been in contact with many independent pharmacies struggling to keep their doors open.
"Legislators realize there is an issue and we are working hard to address it," Tosh said. "We are working with Representative Michelle Gray, sponsor of the 2015 legislation. We will be working closely with other legislators, Arkansas Insurance Department, Pharmacy Association, Governor's Office and the Attorney General's office to address this. We are looking at possible legislation that will address several key areas of concern, one area will be the calculation of rate of submission from primary carrier, among other issues."
Meanwhile, Cooper said his business brought in a new service to help make up for money lost, such as charging for flu shots at his pharmacy.