FROM MEDI-CAL DEFENSE FUND
MDF filed its new state court suit on Dec. 3, 2012, on behalf of CKAPhA, PPA, and pharmacies and beneficiaries, to stop the double 10% payment which was scheduled to start on February 7, 2014.
In response, two weeks later, on Dec. 18, 2012, DHCS posted a list of nearly 3000 drug products which it has now determined should be exempt, called the "Exempt Drug List," from the double 10% cut.
DHCS stated on Dec. 18 that it was asking CMS to exclude the drug products listed on this Exempt Drug List from the cut, (however, only for periods after March 2012).
DHCS has now officially, on Jan. 8, 2014, publicly announced this new DHCS determination that this list of drugs should be exempted from the 10% cut (but only for the period after March 2012), by official email from Harry Hendrix, Jr., Chief, Pharmacy Benefits Division, DHCS. (Harry Hendrix's email, below).
See also, a copy of the Exempt Drugs List, attached.
(This Exempt Drugs List appears to us to include virtually all drugs in the Medi-Cal program. If we are wrong about this, please let us know right away.)
So, we think that our MDF lawsuit, supported by CKAPhA, PPA, CPhA, and many other groups and pharmacists, has already upped the ante and forced or tended to persuade DHCS to at least take this important step away from implementing this disastrous pharmacy payment cut.
But DHCS although now admitting in essence that access will be destroyed unless these drugs on the Drug Exempt List are exempted, is nevertheless, still insisting it is going to implement the double 10% cut on these drugs on the Drug Exempt List, anyway, unless CMS approves its proposed State Plan Amendment SPA 12-014.
But, even if CMS does approve SPA 12-014, nevertheless, all drugs which were dispensed in the 10 months prior to April 2012 (i.e. drugs furnished June 2011 through 2012), -- including all the List of Exempt Drugs, -- will still be subject to recoupment by DHCS, anyway! for this ten-month period! -- for which deductions of 5% will still be taken by DHCS until the State's "recoupment claim" for this first ten months is fully "repaid" by State recoupment seizures from State payments earned by you.
Meanwhile, to end this craziness, the motion of MDF for an injunction to stop the entire AB 97 10% cut for all drugs, is scheduled for hearing on January 28, 2014 in San Francisco Superior Court, which will be decided entirely on state law, not, on federal law at all.
Obviously, it would take a good deal of the pressure off, if CMS were to now approve SPA 12-014, (even though this would still leave the cut in existence for drugs furnished during the 10 months June 2011 through March 2012).
So, as to this part of the situation, we at MDF are requesting pharmacy leaders and all pharmacists who read this MDF Bulletin, to immediately write and contact personally if you can, CMS, CMS officers, and your Representative in Congress, and your Senators, to demand that CMS (1) disapprove and cancel this 10% cut for all drugs for all periods, or alternatively, at the very least, approve SPA 12-014 at once, before Feb. 7, 2014, so as not to destroy the Medi-Cal program; and, write Governor Brown to demand that he contact President Obama and HHS Secretary Kathleen Sebelius, to stop this 10% cut entirely.
One high officer to write by overnight express mail at once is:
Gloria Nagle, PhD, MPA
Associate Regional Administrator
Centers for Medicare and Medicaid Services
Division of Medicaid and Children's Services
90 7th Street, Suite 5-300 (5W)
San Francisco, CA 94013-6707
If you wish to support MDF, please made your donation check payable to Medicaid Defense Fund and mail it to:
Medicaid Defense Fund
404 San Anselmo Ave.
San Anselmo, CA 94960
Lynn S. Carman
Medicaid Defense Fund