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SPONSOR: |
Sandoval |
DATE TYPED: |
02/08/02 |
HB |
440 |
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SHORT TITLE: |
Prescription Drug Minimum Dispensing Fee |
SB |
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ANALYST: |
Weber |
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APPROPRIATION
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Appropriation
Contained |
Estimated
Additional Impact |
Recurring or Non-Rec |
Fund Affected |
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|
FY02 |
FY03 |
FY02 |
FY03 |
|
|
|
|
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$0.1 |
Indeterminate |
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|
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|
|
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(Parenthesis
( ) Indicate Expenditure Decreases)
New Mexico Board of Pharmacy
Human Services Department
New Mexico Health Policy Commission
SUMMARY
Synopsis
of Bill
House Bill 440 (HB 440) would amend the Drug
Product Selection Act (27-2-16B NMSA 1978) to eliminate references to specific
dispensing fees for prescriptions reimbursed by Medicaid where drug product
selection is permitted by the act. The
amendment would allow “a reasonable dispensing fee" without specifying a
mandatory minimum fee.
No appropriation is
included in this bill.
Significant
Issues
HB 440 would have a significant impact on the
pending lawsuit Starko v. [Human Services
Department] HSD. The Starko plaintiffs, a certified class of
New Mexico pharmacies, claim HSD is in violation of 27-2-16B by contracting
away to Managed Care Organizations (MCOs) its duty under the statute to
contract directly with pharmacies that believe they do not have to comply with
27-2-16B. The plaintiffs claim that
managed care is included under 27-2-16B, so MCOs must pay the $3.65 dispensing
fee instead of their negotiated dispensing fees, which average around $2.00.
HB 440 would remove the statutorily mandatory
$3.65 minimum dispensing fee, allowing the MCOs and HSD's Medical Assistance
Division (MAD) to negotiate dispensing fees with the pharmacies. The interpretation of “reasonable dispensing
fee” could become an issue and result in legal challenges.
The Board of Pharmacy
reports, that the cost of many medications run into the
hundreds of dollars and yet the dispensing fee has remained at $3.65 per
prescription which may not be a fair mark up to the retail pharmacy. The Health Policy Commission adds that a
lower dispensing fee could put greater financial burden on the retail pharmacy
in what is already a low profit margin business. This is especially true for smaller non-chain based pharmacies
that likely exist in New Mexico’s smaller and less populated communities.
FISCAL IMPLICATIONS
HB 440 could have the
effect of raising or lowering the Medicaid prescription drug costs depending on
the final dispensing fee.
CONFLICT/DUPLICATION/COMPANIONSHIP/RELATIONSHIP
HB-400 is similar.
POSSIBLE QUESTIONS
It may be valuable to establish the exact dispensing fee to eliminate
confusion and possible litigation over what is a reasonable fee.
[1]Begin typing on the * in replace mode. Do not add or delete spaces.