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California Medicaid Cuts – Ground Zero

·2340 words·11 mins

Yesterday the California Medicaid system (Medi-Cal) cut reimbursements by 10% across the boards for Doctors, Dentists and Pharmacies.  For pharmacies this was both the dispensing fee AND the drug cost reimbursement.

Yesterday is also the day where if your MediCal Rx costs over $150, pharmacies will lose money due to the state reimbursing below the dead net cost.  See that Risperdal prescription that cost the pharmacy $200? The pharmacy lost $30 on that deal (reimbursed $170).  What makes this obvious clusterfuck more amusing, is that the state has under the table “rebates” ie: kickbacks that mandate certain trade drugs.  See generic prilosec? The state only reimburses for Nexium and Prevacid (now at $30 BELOW NET COST per Rx!).  If the state and Big Pharma would stop space-docking (go look that one up), maybe the state would not be in such a money-hole.  Wait, that makes sense.  What also would of made sense is a 5% cut on trade name drugs and a 15% cut on generics.  Hold on, does the state have any actual “real” pharmacists working for them or are they just “advisors” (ie: couldnt cut it in the ‘real world’ so they had to ‘advise’) who shake hands at the APhA meetings while giving back-room handjobs.  Was this 10% cut just an arbitrary figure by some suit in Sacramento who obviously doesn’t have to deal the fallout? Sure is.  Again, retail pharmacy is the human shield for the idiots in power.

No doubt that California is in a money-hole, but instead of sucking up some form of balls and a backbone and kicking people OFF of the welfare system who obviously should be out working (and contributing to the society that they gleefully suck the life out of (and make more babies for)), they just cut the reimbursement to the people who actually take care of them.   Is there a real legit reason why the 27 year old male who walks into my store should be on the state system with his car stereo blaring the bass out in front?

The state probably thinks that pharmacists and doctors are all rich, they can just work for free!  Yeah, fuck you.  I didn’t put the time and effort to go to school and make something of myself to work for free.  At this rate I should of just been on welfare like everyone else.  California’s tried-and-true idea of a “solution” is to just throw money at the problem and hope it goes away.  Well, I’m sorry, it didn’t and now people EXPECT the state to hold their cock while they pee, wipe their asses when they shit, and $0 copays for everything!  You created this situation and now you expect US to take it in the ass for you.  Again, fuck you.  Its common knowledge that you don’t shit in your own bed, and you dont cut down the trees that provide you with food.

Oh, and because shitting in the faces of the working professionals wasn’t enough, the other insurance companies will look at us and say “Well, if the State can pay you shit, and you deal, then WE can pay you shit and you can also deal”.  Can you all see where this is going?

Heres something else that the State obviously didn’t consider.  What are the highest dollar medications we have.  Ones that there are next to zero generics and people obviously cant switch to something else:

  • Retrovirals (HIV baby!)
  • Cancer/Chemotherapy
  • Atypical Antipsychotics (sorta, haldol is always an option. We can always bring back Clozeril! heh)

So the state now have put pharmacies in a very very tough spot.  Does the pharmacy lose $100 on that $700 HIV medication for their patient, or do they tell the patient “sorry bud, you up shit creek”.  Do those fucked up politicians need to look at that patient in the eyes and tell him/her “Sorry.  You cannot get your medications to prolong your existance because the store cant afford to lose $300 on your 4 HIV meds”.  No, they dont.  Maybe they should though.   Pharmacies (and their patients) that do a ton of mental health/HIV/Chemo drugs are absolutely fucked beyond belief.  Not just a little fucked, but full-on bend-over-bubba fucked. 

So to the California representives who made this clusterfuck:
I refuse to fill an Rx for below cost.  You know those expensive psych meds like Risperdal, Zyprexa, etc? Those aren’t going to get filled.  Maybe you should use your powers of penile stimulation on Big Pharma or just grow a pair of balls and start booting people off of the system.  Doctors aren’t going to take MediCal anymore, pharmacies are going to refuse to fill (ie: not stock) expensive trade name drugs and these people are going to go to their nearest ER at $500/visit to get care.  You shit in your bed, YOU think of a different way to fix it other than letting the shit roll downhill on retail pharmacy.

I forsee many MediCal patients not recieving their medications unless the State pulls their collective heads out of their asses and do something.  Stay tuned for more F-Bombs directed at the People’s Republic of Kalifornia.

Comments #

Comment by nodrugs4u on 2008-07-02 12:38:32 -0700 #

I work for a big chain. The company is also concerned about this. Apparently there is a coalition of big chains to fight this. Hopefully, the chains will stop undermining each other long enough to convince the state to either reverse this or at least lower to reduction rate. I don’t understand why the third party payers will rather pay us 50 cents or $1 less here and there, but end up payings thousands on tests and procedures in the hospitals.

Comment by on 2008-07-02 16:05:00 -0700 #

this is just another fucking example how the industry and the government just fuckin screws us without understanding the situation. They fucking think we are gonna just sit there and bend over? fuck one with any ounce of common sense runs a business just to sell at a loss..WTF

Comment by Sorcha on 2008-07-02 18:48:03 -0700 #

Yeah, well if Medi-cal would pay for the cheap-ass generics instead of INSISTING on the expensive brand then maybe they wouldn’t have this problem. Gods I am happy I got out of the pharmacy when I did.

Comment by Google Account on 2008-07-02 19:10:57 -0700 #

Damn! It just goes to prove what I’ve been saying for awhile: The government, state and feds, believe wholeheartedly that an ignorant,needy public is an ideal situation for the politicos to do as they please. Put the whole fucking nation on the dole–and force those who bothered to educate themselves and actually pay their way through life to pay for everyone else. Are you making money? Good! The government has some fucked up white trailer trash barbie with her 3.5 kids (all with a different baby daddy) that you can have the pleasure and privilege of being drained of all your benjamins to support her, her kids, her drug habit and give the poor thing time to find another baby daddy. Way to go! Here we come Socialism! Message to the masses: getting educated and making money is a good way to find yourself taking care of those lazy fucks you went to high school with. Between California’s laws (how about PGE controlling your ac from their hubbs?) and Obama wanting to punish all those nasty greedy oil people, well, hell, what hope do we have?

Comment by frank on 2008-07-02 19:40:33 -0700 #

Its like a whore complaining of being fucked. How many times have PBMs and state plans have cut our fees? How many times have we raised our voices? They keep sticking it to us , till we actually act like we care.
How many of you RPHs out there belong to any organizations? What was the last time you actually voiced an opinion to your lawmakers?

Comment by RJS on 2008-07-02 20:27:55 -0700 #

Fucking nice. It’s nice to see people standing up to The Man and telling him to fuck off when it makes sense to do so.
I hope the chain pharmacies out there are doing the same thing. Are they?
You should come to NH, TAP. Live free or die is our motto, and it applies to just about every facet of NH life. No sales taxes, no income taxes. You sink or swim on your own. Of course, this cuts both ways, as in-school tuition at UNH is more expensive than attending UMass out of state, for example. On the other hand, there’s very little Medicaid, and almost no state assistance for anything. (All the welfare moms move to Massachusetts when they get pregnant, because MA will take care of them, whereas NH will not.)
Give me personal responsibility over Nanny State any day of the week. But then I’m just a poor (stupid?) SOB who actually works for his money.

Comment by rph3664 on 2008-07-02 20:47:24 -0700 #

Yeah, Clozaril’s available as a generic now, but you still have to do the weekly blood draws.
From what I have seen, it’s mostly used for Parkinsonian dementia, and is therefore the nursing home supplier’s problem.
Illinois Public Aid has been up to a year behind at times, but at least it’s not at as big a loss as California.
Deport the illegals!

Comment by Drugmonkey, Master of Pharmacy on 2008-07-02 22:57:48 -0700 #

Interesting, TAP. Just one question for you though.
Who’d you vote for in the recall? Because this 10% cut is most certainly the child of one man.
Or maybe one half-man half-robot.
Schwarzenegger’s budget included a 10% cut in almost all state departments. As it stands now, it looks like a deal is gonna be worked out to spare the park system.
Because the trees have an effective lobbying organization, and we have APhA.

Comment by Sean on 2008-07-04 20:06:30 -0700 #

at least risperdal went generic last week….not a whole lot a difference right now, but it will…..
medicaid reimbursment sux!

Comment by Jason on 2008-07-06 09:12:54 -0700 #

I’ve been watching the reimbursements from MediCal over the past few days and on one day we lost ove $600 on RX’s. I work for a medium-sized chain and we may be able to absorb this kind of loss for a month or so, but what about the independents? Last year our local children’s hospital refused to resign a contract with a HMO MediCal provider because they were losing money. What happened? About a year later after hearing all of the complaints from their participants the plan renegotiated the contract. If one of the chains would step up and say “Enough is enough,” maybe the rest of the chains would follow suit and then the state woudl have to rethink their position.

Comment by Drug Whore in Canada on 2008-07-06 09:52:08 -0700 #

Wow–you can refuse to fill a RX if you are going to lose money
Not here
In Ontario

  1. our college would take an apeshit and have you up before the board faster then you can count by 5s to 100.
  2. the Ontario govt sets down the prices it will pay for a drug..period. The manuf. says, no we are charging more so there. By law we have to fill the RX and absorb the loss. Got to love it.ONLY IN CANADA.

Comment by Google Account on 2008-07-09 14:43:15 -0700 #

“at least risperdal went generic last week….not a whole lot a difference right now, but it will…..
medicaid reimbursment sux!”
The problem is, as TAP said, the state will only pay for the branded Risperdal at less than cost, not the generic, because they are “space docking” with the big drug companies!
According to CPHA the 10% cut will be lowered to 5% on September 1st. Meanwhile, pharmacies will be taking it up the ass…

Comment by on 2008-07-09 15:30:59 -0700 #

Yes, CA Medi-Cal has definately lost their minds. I have an independant pharmacy and over the last few days I have lost so much money… Filled Risperdal-lost $40; Catapres TTS patch-lost $30; Abilify-lost $30. If I fill enough of these every day I’ll definately be out of business. What is Schwarzeneger thinking? How can they ask-rather demand us to take this. What business do they demand to be reimbursed severely less than your cost. They do it under the act that it’s medicine, & it’s so important patients need their meds-so what if the pharmacy suffers a big loss each time they fill prescriptions. Why should we have to fill ANY drug at a loss? These goverment people are so unbelievably screwed up!!!

Comment by Todd on 2008-07-10 00:58:46 -0700 #

I just saw a woman the other day picking up 90 suboxone tablets for a ZERO dollar government funded rx co-pay. What a complete waste of tax dollars >.<
Maybe the government deals with pharmacies like Wal-mart that claim “O yeah sure we can take a loss on pharmacy, because it will get foot traffic in the store and we can sell them other stuff!”
I remember a woman from a few days ago on government funded medicaid complaining about why she can’t use her new Rx coupon for government funded prescriptions! “WHY can’t u just override the register?! They have done it before for me!?”

Comment by Jeff on 2008-07-14 06:45:06 -0700 #

good news, apparently overturned by a higher court, but e’ll see for how long…

Comment by Google Account on 2008-08-04 17:30:34 -0700 #

Hey I just noticed today that they’re paying Family PACT claims at the old rate (no 10% cut). I went back and reversed re-billed all the claims from 7/1 through 7/17. They fixed the problem on the 18th. Just a heads-up in case anyone cares. I called EDS early last month to complain about it and of course I got a brain dead telephone room person who had no clue and kept me on hold for 40 minutes only to give some lame answer that made no sense. I guess they must have gotten a lot of calls.