A new state program will provide up to $10 million to help independent pharmacies that serve Medicaid customers in small communities. The Illinois Department of Healthcare and Family Services is launching the Critical Access Care Pharmacy Program.
State Sen. Andy Manar, D-Bunker Hill, who has been pushing for the funding, said in a statement that the program provides $10 million in additional funding to keep rural, independent pharmacies open. Furthermore, Manar says the Critical Access Pharmacy Program was included in last year’s state budget, but implementation was stalled by then-Gov. Bruce Rauner.
Garth Reynolds, executive director at Illinois Pharmacists Association, says the $10 million is a line item in the state budget funding the Department of Healthcare and Family Services or Medicaid. “It’s a line item that’s specifically to be used for critical access funds. It comes from the allocation for HFS.”
Reynolds said the pharmacies are thankful for the assistance from legislative leaders and budget negotiators, but the funding doesn’t solve all the problems. “It’s giving some interim financial relief as we contest with the larger unbalanced reimbursement concerns with managed Medicaid.”
To meet the eligibility criteria for the funding under the program, Reynolds says the pharmacy has to be physically located in the state, meaning the pharmacy has to be a brick-and-mortar store that is open to the public and is able to fill prescriptions. Additionally, the pharmacy has to have an ownership or control interest of fewer than 10 pharmacies and the pharmacy must be located in a county with fewer than 50,000 residents.
Locally, Andy Gee, owner at Plum Street Pharmacy in Carmi says, “This program is critical to pharmacies that provide services to Medicaid patients. The reimbursement for such services has decreased to around cost or even below cost in many instances which is unsustainable for any pharmacy, whether they are an independent or a chain. This program is not designed to be a fix, it is a landing area until we can get legislation passed like HB 465. HB 465 has strong bipartisan support and it is the first step toward PBM regulation within this state. Many states have passed similar legislation in the past year following the lead of Ohio which exposed a few of the ways that the PBMs extract dollars from the healthcare system. HB 465 has passed both the house and the senate unanimously and currently sits waiting for the governor to sign. I feel strongly that the current payer system is too monopolized and must be changed to protect both the consumer and the healthcare professionals.”