Patient Access to Generics at Risk Due to Inadequate Reimbursement Rates

Current reimbursement rates that fail to cover the cost of filling prescriptions is putting the patient's access to generic prescription drugs at risk, according to a survey of community pharmacists.

Current reimbursement rates that fail to cover the cost of filling prescriptions is putting the patient’s access to generic prescription drugs at risk, according to a survey of community pharmacists.

The National Community Pharmacists Association (NCPA) found that in the past 6 months close to half of respondents said they experienced at least 51 instances of large upswings in the acquisition price of a generic drug. Only 1 respondents said he or she hadn’t experienced such an upswing during that time.

"For decades community pharmacists have promoted the appropriate use of generic drugs to lower costs," NCPA Chief Executive Officer B. Douglas Hoey, RPh, MBA, said in a statement. “However, more recently the price for some of these medications has skyrocketed 1000% or more virtually overnight while reimbursement rates paid to community pharmacists have inexcusably lagged behind for weeks or months.”

Nearly all (93%) of respondents said that the situation of generic drug price spikes has gotten worse since 2013. In addition, it takes pharmacy benefit managers and third-party payers 3 months or longer to correspondingly update pharmacy reimbursement rates, according to 62.3% of respondents. This slow reaction results in a financial loss for community pharmacists, and again 93% said the situation has gotten worse in the last 2 years.

Some of the most commonly cited medications with instances of below-cost reimbursement were Benazepril (high blood pressure); Budesonide (asthma); Haloperidol (psychotic disorders); Levothyroxine (hypothyroidism); and Pravastatin (high cholesterol and heart disease).

"This survey finds that this problem has only grown more severe over the past 2 years and requires urgent attention from federal and state policymakers," Mr Hoey said. "Community pharmacies cannot be expected to continually fill many prescriptions at a significant loss. Ultimately patients are impacted as well.”

He added that some patients already skip their medications because of increasing prices and copays or they are being forced into the Medicare coverage gap sooner.

“Others will likely find it more difficult to find certain generic drugs at all because their pharmacy can no longer afford to stock and dispense them,” he said.