September 15, 2008
Today, the Federal District Court considered three separate motions in the Independent Living Centers case. The first motion, filed by the State, was to stay the Court’s order granting the Preliminary Injunction that stopped the 10% cut to Medi-Cal provider payments. If granted, this would essentially put the injunction on “hold” and reinstate the 10% cuts. Fortunately, that motion was denied by the Court and the Preliminary Injunction will remain in place.
The second motion was filed by a number of Medi-Cal providers to intervene (or join) in the case. This motion involved representatives of physicians, dentists, adult day health care centers and hospitals. With these providers in the case, the plaintiffs will have greater resources available to contest any appeal of the District Court’s ruling. The motion was granted with regard to physicians, dentists and adult day health care centers. The hospitals were not allowed to intervene due to a procedural rule.
The third motion was filed by the State to clarify the Court’s order granting the Preliminary Injunction. With regard to pharmacies, the State argued that the injunction should apply only to “prescription drugs” instead of “pharmacies.” The Court essentially granted this request. In doing so, the Court stated that its intent was to grant the relief sought by the plaintiffs. The Court noted that the evidence presented in the case focused on the effect of the 10% cuts on reimbursement for prescription drugs. The Court held that the injunction “ . . . is limited to prescription drugs, which includes both drugs that cannot be dispensed without a prescription as well as prescribed over-the-counter drugs that were previously available only by prescription.” This last phrase is still a source of confusion. In practice, this means that some, but not all, OTC drugs will be covered by the injunction. Just which OTC drugs will be covered likely will be determined, at least initially, by the State. While a final ruling on this motion is not expected for a few more days, we expect the Court’s final ruling will be as described above.
Once finalized, the effect of the Court’s action today will be:
- We now have a final injunction that clearly applies to the prescription drugs that were resulting in the biggest losses for pharmacies;
- It is clear that the injunction does not apply to most OTC drugs, medical supplies, DME and other products provided by pharmacies under the Medi-Cal Program;
- The next step for the State is to pursue its appeal of the District Court’s order granting the Preliminary Injunction in the Ninth Circuit Court of Appeals – discussed below.
- EDS will need to reprocess claims for dates of service between August 18 and September 5. Some of the reprocessed claims will result in additional reimbursement to pharmacies; some will result in reduced payments to pharmacies.
As noted above, the State has filed an appeal of the District Court’s ruling granting the Preliminary Injunction. The Ninth Circuit Court of Appeals has granted an expedited briefing schedule for this appeal. The State’s opening brief is due by September 25; subsequent briefs will be filed within the following 60 days. Exactly when the Court of Appeals will hold oral arguments and issue a ruling on the appeal is not yet known.
This is a much quicker schedule that we initially anticipated, but it is not expected that the Court of Appeals will issue a ruling before the end of the year. It is hoped the appeal will be heard by the same panel of judges that initially heard this case in July and which issued the decision that ultimately resulted in the Preliminary Injunction from the District Court. As in the past, we will keep you updated on the progress and any developments in this case.
September 8, 2008
The Deparment of Health Care Services (DHCS) just posted recent information to its website in response to the August 18 preliminary injuction court order, halting cuts to the Medi-Cal program. Click here for more information directly from DHCS.
August 14, 2008
We are at a critical juncture. We have been told that there is likely to be a vote on the State budget this weekend. Therefore, it is imperative that you call, fax or email your legislators immediately with the following message, which you can modify if you like. In any case, this must be done TODAY or tomorrow. This may be our last chance to have the Medi-Cal cuts completed removed. Click here to send your message today
Dear (name of Legislator):
As a community pharmacist in your district, I am greatly concerned about patients' access to their medicines. The 10% cut to the Medi-Cal reimbursement rate that went into effect on July 1, 2008 will force some pharmacies to stop filling Medi-Cal prescriptions, reduce hours or be forced to close.
Pharmacies that serve a large number of Medi-Cal patients might find it impossible to stay in business, which would impact the entire community, including all patients, not just those who are Medi-Cal beneficiaries. Patients cannot afford to lose access to life-saving medications.
No health care provider should be asked to participate in Medi-Cal at a loss. We ask you to take action to fully repeal the 10% cut and return pharmacy to former reimbursement levels (5% is still a loss) so that vital pharmacy services to patients throughout the State can be maintained.
Thank you for taking this critical action to support community pharmacy and all patients in California.
July 9, 2008
We have had a chance to survey our partners and assess the situation surrounding the 10% cuts to Medi-Cal more thoroughly over the last few days. Here’s what we know today, Wednesday, July 9, 2008. Read more >>