Report to Congress. Pharmacy Reimbursement Rates: Their Adequacy and Impact on Medicaid Beneficiaries

摘要

The purpose of this study is to describe the adequacy of State Medicaid payments to pharmacies, as measured by their relationship to average costs, and to measure the effect of these payment levels on access of enrollees to pharmaceutical services for a recent year. A major determinant of whether a pharmacy decides to provide services to Medicaid enrollees may be the adequacy of State payment for the cost of obtaining and dispensing prescriptions to Medicaid enrollees. If profit margins for Medicaid services are too low, pharmacies may be inclined to limit their involvement in the Medicaid program. Although the adequacy of payment could be measured by comparing Medicaid payments to those of other third parties, a more direct measure is the relationship of State payments to the cost of obtaining and dispensing the products. The weakness of this approach is that estimates of these costs have been difficult to obtain, especially across all States. A major goal of the present study is to derive estimates of costs for each State.