Pharmacists Say They Take Hit In Medicaid

Health News Florida

January 31, 2020

Amid a legislative tussle with millions of dollars on the line, people who operate pharmacies in Florida contend they are getting short-changed by the state.

State Medicaid officials estimate the cost of doing business in the Medicaid program is $10.24 per filled prescription. But on average, Medicaid managed-care plans paid pharmacists $2.72 per claim in 2018.

The 202-page analysis was commissioned by the Florida Pharmacy Association and American Pharmacy Cooperative Inc. and was conducted by 3 Axis Advisors. It was based on a review of more than 350 million Medicaid managed-care claims between 2012 and 2019 and claims data from more than 100 small community pharmacies across Florida to help validate the state data.

The claims showed researchers what each managed-care company reported paying for each drug to each pharmacy and how some pharmacies are paid more than others. The study comes as the Legislature considers bills that would address the role of pharmacy benefit managers.

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