In this episode, we will update you on the Medi-Cal crisis in California where 3 million Californians stand to lose access to life-saving medications for conditions such as HIV, Cancer and mental health.

The clawbacks have started and pharmacy reimbursement has plummeted due to NADAC pricing and a fundamentally flawed survey and system.





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What You Will Learn:

  • Updates on the clawback
  • Shocking reimbursements
  • Status of the lawsuit against the California Department of Healthcare Services
  • What pharmacists are doing
  • What you can do

About MichRx Pharmacist Consulting Services:

MichRx Pharmacist Consulting Services is a healthcare and training company providing state of the art Medication Therapy Management (MTM), Chronic Care Management (CCM) and telehealth consulting with a focus on HIV Care, resulting in improved patient outcomes and increased profits for our clients.

About Ubuntu Pharmacist Care Program:

The Ubuntu Pharmacist Care Program is a unique advanced practice MTM (Medication Therapy Management) CCM (Chronic Care Management)and DSM (Disease State Management)  pharmacist consultation program of MichRx Pharmacist Consulting Services, Inc.

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It’s an update on the California Medi-Cal clawback and NADAC pricing reimbursement issue that’s going on in California right now. Off to being a pharmacist for so many years and seeing so many things happen in the pharmacy and legislation changes and things like that, I’ve always said, I can never say I can’t believe it because something pops up every day that it’s like, wow, that happened.

So I never say I can’t believe it, but on this situation and literally have no words, there are no words to express dismay and shock and sadness, if you would, and lack of consciousness on the part of the powers that be who could actually think that the institution of such a program is okay on so many levels.

The clawback began on May 31st of this year and immediately pharmacies across California started receiving these clawbacks. No pharmacist knew what the clawback was, how much was going to be taken back, but tens of thousands, millions of dollars in some cases were clawed back by the Department of Healthcare Services and the medical program just for April of 2017!

What program? What business in this country do you do business with? You get paid for your services in two years later they come back and they say, oh wait, we are taking our money back.

It’s egregious. It doesn’t even make sense. It’s just a modern day form of highway robbery being robbed, blind for services that you provided to patients two years ago, great services, great health care. It doesn’t make it any sense. This initial and clawback were thousands and in some cases in some pharmacies, tens of thousands of dollars for one month.

The next one that’s going to be on the first cheque Medi-Cal check for July is going to be three months. It’s going to be June, July, and August of 2017 how do pharmacy sustain themselves?

How are they going to survive? This has to stop and we all know because what’s going on from previous, Conscious Pharmacist’s Podcast, the methodology of this clawback was completely flawed. People who have no experience with drugs, drug reimbursement created the survey that had very little responses, very little response. They had three responses from specialty pharmacies.

Three, it’s skewed the data and they threw those out. Specialty drugs, drugs like HIV medications, cancer medications, antipsychotics, and mental health groups should be carved out of this program because they’re exponentially skewed.

Pharmacies are filling prescriptions for Medi-Cal recipients right now and losing money on every single prescription. That is not a sustainable business model.

None of these pharmacists are looking to profit from anybody. We just want to be paid fairly. It’s the only reasonable thing. And then in February when this NADAC reimbursement went into place, again, complete flawed methodology, we have to stop this. Every HIV prescription that’s being reimbursed is being reimbursed in a massively negative margin from our cost.

How can something, the national average drug acquisition cost be the basis of which for which pharmacist of being reimbursed some pharmacy in Arkansas or Oklahoma or somewhere else in the country, what they cost is with the drug, does not equate to the cost. What some pharmacies are paying here in California, how could this even be a measure?

How could it actually be a measure of 60,000 pharmacies when they only looking at 400 to 600 pharmacies who voluntarily might submit the invoices? This is such an egregious methodology.

It needs to go right away. So what can we do about it? Pharmacists and the California Pharmacists Association and mobilized in California to create, our RX Fairness

It’s a coalition as the Californians for access to lifesaving medicines, which is a coalition of pharmacists, pharmacies. And any other stakeholders who are willing to participate to create a campaign against this egregious, um, rule that governor Jerry Brown sound is signed into law. What needs to happen is get Governor Newsome needs to act immediately to in this clawback, a lawsuit has been filed against the Department of Healthcare services for this clawback and the NADAC pricing.

And hopefully, a judge will provide an injunction to stop the clawback right away until through the investigation could be done with this. So my appeal to everybody that’s listening. If you’re a pharmacist, a student, a pharmacy owner, join this coalition, Californians for access to lifesaving medicines so the coalition can raise money to fight back on all these egregious harmful activities that are affecting pharmacies.

But most importantly, over 3 million Californians could lose access to life-saving medication, HIV medication, cancer medication, those suffering from mental health issues, people will die as a result of this. So we have to stop this activity.

The Californians for access to lifesaving medicines. Not only are they fighting this, which is the immediate life-threatening threat to patients and pharmacies alike, but also mounting action against PBMs and the egregious Dir fees that need no explanation.

We’ve talked about that over and over. We have to join the fight. We have to take action. We also need to encourage our patients to take action soon.

Governor Newsom with the act of his signature and his pain could stop this activity immediately in its tracks.

So I encourage you to sign the letter, encourage your patients to sign the later so that we can prevent this catastrophe in California, not only in this medical thing, but then work to fight an into the Dir fees, the egregious practices of PBMs and the light so that we can fight for our patients.

We can do these people, we have to look at things on a conscious level. Clearly, the people that came up with this idea of NADAC and as well as the methodology here in California to implement it or clearly completely unconscious. If we started to be conscious and looked at things on a conscious level at like, how is this going to affect pharmacy? Does this even work? Have people involved, stakeholders involved who do this every day have patients involved?

If we look at this on a level of consciousness, we can make the change. We can prevent this from ever happening again, so I urge you, join the coalition are all this information is on our site. Sign the letter to Governor Gavin Newsom. Let’s get mobilized, people. Let’s be conscious we can make the difference. We can make the change.

Remember be the change.