LAKE COUNTY — A reduction in the amount pharmacies get back for medicines covered by Medi-Cal is forcing small, privately owned pharmacies in Lake County to make a tough decision: Pay out of pocket to fill the prescriptions or lose customers.
The cut means Medi-Cal reimburses pharmacies for 10 percent less than what the pharmacies pay to fill Medi-Cal prescriptions. Owners of small pharmacies in Lake County say they are either paying out of pocket to fill those prescriptions, or they are sending patients to large chains such as Longs, Kmart and Rite-Aid.
“When Medi-Cal is reimbursing you 10 percent less than what it costs you, you can”t be in business,” Lake Pharmacy manager Dave Wood said.
Lake Pharmacy in Clearlake is one of the county”s privately owned pharmacies feeling the squeeze since the cut became effective July 1. At issue in the ongoing state budget discussions is whether or not Governor Arnold Schwarzenegger will retroactively reimburse the 10 percent cut to Medi-Cal, which is a health care program for low-income and disabled patients.
Middletown Pharmacy owner Ralph Larssen said he stopped accepting Medi-Cal prescriptions July 1. Transportation to chain pharmacies that still take the prescriptions can be a problem for Medi-Cal patients, he said.
“Since then, I”ve had a few customers come back and ask what can be done because they don”t have the money to pay for the gas and they need their medications now,” Larssen said.
Larssen said Medi-Cal only pays for brand names in some cases, ratcheting up the price and increasing the gap between what the pharmacy pays for the drugs and what the state reimburses.
“For example, in the case of Ambien (a prescription sleep aid), the generic came out earlier this year, but Medi-Cal requires us to dispense the brand name,” Larssen said.
He said the pharmacy pays $415.87 for 100 of the brand-name pills. The generic version of the drug costs $31.70 for 1,000 pills, according to Larssen.
“We had one woman come in the other day and offer to make up the difference. But that”s against the law. And she”s been our customer for a long time, so we took a $200 loss. We either have to take the loss or lose the customer,” North Lake Medical Pharmacy owner Bill Kearney said.
Kearney said his North Lakeport pharmacy is still filling Medi-Cal prescriptions, but at an estimated $500 to $600 weekly loss. He said Medi-Cal patients represent approximately 30 percent of his business.
Larssen said he worked for six years on pushing legislators to pass HR 6331, a bill passed in July that will allow small, independent pharmacies to band together to order drugs at the wholesale prices that are currently only available to pharmacy chains. He said that bill will take effect in Jan 2010.
Contact Tiffany Revelle at trevelle@record-bee.com.
