Medicaid Physician Drug Program Reimbursement — Is It An Issue for Your Practice?

Due to a rate freeze in Medicaid’s Physician Drug Program that occurred in 2010, a growing number of physician-administered drugs and devices are reimbursed at rates below cost. NCMS staff recently met with officials from the state’s Division of Medical Assistance to discuss this issue and examine ways to bring reimbursements in line with our members’ cost for pharmaceuticals used in treating their Medicaid patients.

DMA officials confirmed what we’ve heard from our members thus far. Many oncology and rheumatology drugs, vaccines, and long-term reversible contraceptives (to name a few) are cited as costing physicians significantly more than they are being reimbursed by the program. And as more time passes, more drugs move into this “underwater” status. DMA acknowledged this can become an access to care issue, and expressed willingness to work to reduce the gap in reimbursement.

As the NCMS continues to address this matter, it would be helpful to get a fuller understanding of if – and how dramatically – your practice is affected by these below cost drug reimbursements. Please post your comments at the end of this article, and watch the Bulletin for updates as our work on this issue continues.

 
 

More Posts in Bulletins

 
 

Share this Post



 
 
 

2 Comments

  • Our physicians administer high cost drugs for treatment of AMD and other sight threating conditions. We can not continue long term treatment with preferred drugs due to the loss incurred.

  • Dinesh Chandra

    I have stopped giving Procrit for anemia in renal failure. It costs me more to provide this in the office. I do not give even to patients with Medicare and medicaid, because medicaid does not pay the full co pay. These patients go the hospital clinic and I am sure it will cost more for Medicaid. Unfortunately, this is the reality of private practice in our state. Their goal is to eventually destroy private practice as we know it