A Community Pharmacist Speaks Out: What Med-Cal Cuts Passed Earlier This Year Means to My Patients—And the State of California

[courtesy of California Progress Report]

By Jerry Shapiro
Pharmacist

The 10% across the board Medi-Cal provider cuts that were passed almost unanimously by both Houses of the State Legislature and signed by the Governor spell doom for both patients and providers. Once again a group of politicians made no effort to get input from either the beneficiary or provider groups. They just took an axe and cut away 10% of the budget deficit. Paying no attention to what these cuts will do in the short term as well as the long term.

In the short term, all expensive life saving drugs will be effectively removed from Medi-Cal other than getting them via hospitalization. This is a rather costly way to provide prescription drugs to patients.

One example of a drug in this category is Thalomid. It is used for multiple myeloma and we use a lot of it. In a quantity of 84, which represents the patient taking 3 capsules a day for 28 days, the reimbursement goes from a current gross profit of $303.38 to a gross loss of $477.02. This is based on a drug that costs our pharmacy $7,856.97. In study after study any drug that has an Average Wholesale Cost of $95.00 or more, the pharmacy begins losing money. It is true that chain drug stores get a slightly better price in purchasing these drugs, but this 10% cut will eliminate their ability to fill these prescription drugs at a profit as well.

Most of my patients have Diabetes, Coronary Artery Disease, Kidney Failure or Cancer to name a few. To treat any of these conditions takes medications that are very costly. What will happen to these patients? As I said earlier they could be hospitalized and hopefully receive these life sustaining medications. This would overload our already overloaded hospital system. More than likely, they would just stop getting these medications resulting in death or at the very least severe complications. This would require additional treatment, another added expense for the already strapped Medi-Cal system (which currently ranks in the bottom three of all states in expenditure per patient).