Posted At Journal Now.com

BY : Mary M. Shaffrey

Congress has a lot on its plate before recessing for the year, including ironing out major differences in proposed changes to Medicaid.

One proposal has raised the ire of community pharmacists who fear they would be forced to lay off employees - or even worse, close - if a proposal goes through changing the way Medicaid reimburses them for prescriptions.

"It won't close my store, but it will hurt," said Dave Marley, the owner of Marley Drug on Peters Creek Parkway. Marley said he would probably have to lay off a full-time and a part-time employee as a result of the changes.

Beverly Graham, the owner of the Medicap Pharmacy in eastern Winston-Salem, was more blunt.

"I can't sell things for less than my cost," she said. "I can't afford to do that. There's a possibility I'd have to stop taking Medicaid, and if I did, I don't know how I would survive."

Marley and Graham, along with some other local pharmacies, have joined forces with the National Community Pharmacists Association to put pressure on members of Congress to think before they act. NCPA has been placing ads in local newspapers, including the Winston-Salem Journal, that argue against the changes.

The provision would change the complex financing formula for how pharmacies are reimbursed for generic and brand-name drugs, and would affect all pharmacies. But because smaller pharmacies do a larger share of their business from filling prescriptions, including Medicaid, they say they believe they would be adversely affected.

Marley estimated that about 13 percent of his business is from Medicaid. Graham said that her Medicaid business was somewhere between 10 and 50 percent.

Under the current rules, a pharmacist has the ability to call a doctor and ask if a prescription can be filled with a generic equivalent, if such a drug exists.

This would not change, but the incentive for the pharmacist to make this call would, local pharmacists said.

The generic drug is often much less expensive than the brand name. If the doctor says that a substitution can be made, then the generic drug is dispensed.

In addition to saving the patient money, the pharmacist often makes more of a profit selling the generic than he or she would selling the brand name.

For example, Marley used two heart medications to illustrate the point. Altace does not have a generic prescription. Vasotec does. Under the current rules, Marley would make $8.62 on a prescription for Altace, which would have cost the government $110.34 to fill. He would make $14.37 on a prescription for the generic of Vasotec, however, which only cost the government $16.55 to fill.

The changes would decrease pharmacists' profit margin on generic drugs and eliminate any incentive to use them, pharmacists said.

Not so, says U.S. Rep. Joe Barton, the chairman of the House Energy and Commerce Committee, which has oversight of changes to Medicaid.

In a letter to the president of NCPA, Barton said his committee has found that the amount of money pharmacies get from Medicaid reimbursement programs "far exceeds" the cost. He said that the ads placed in the Journal and other publications are "alarmist and misleading."

"The changes to Medicaid prescription-drug reimbursement ... simply aim to base reimbursement on actual market prices, plus a reasonable dispensing fee," said Barton, R-Texas, in his letter to NCPA President Tony Welder.

Barton noted that in addition to the changes to the reimbursement formula, states would be required to pay a flat $8 dispensing fee - double the Medicaid dispensing fee - under the proposed changes.