ATLANTA – A member of the Georgia Board of Community Health called on the agency Thursday to reimburse independent pharmacies for prescriptions at the same rate they pay pharmacy chains.
Mark Shane Mobley’s comments came as the board was approving a 6% increase on average of health insurance premiums state employees, public school teachers, and retirees pay to the State Health Benefit Plan (SHBP).
The huge disparity in prescription reimbursements the SHBP pays to independent pharmacies compared to chains came to light in May when Gov. Brian Kemp vetoed legislation that would have required the state plan to reimburse independents at rates no less than the average reimbursement provided to chain pharmacies. The General Assembly had passed the bill in March with just one “no” vote.
Mobley said four independent pharmacies have closed this year because they couldn’t make enough money to stay in business.
“I’ve got pharmacy owners baking cookies and having other side (jobs) to make ends meet,” he said. “If they got paid a fair amount for these drugs, they wouldn’t have to do that.”
In Kemp’s veto message, the governor cited fiscal estimates that implementing the legislation would cost the state Department of Community Health (DCH) $11 million to $45 million per year, funds the General Assembly did not appropriate.
On Thursday, DCH Commissioner Russel Carlson said the agency has an ongoing contractual relationship with CVS Caremark, which runs the SHBP’s pharmacy program.
“We don’t have our heads in the sand,” he said. “We know there are frustrations in this space. (But) we have contractual responsibilities.”
Having said that, Carlson indicated he’s willing to discuss independent pharmacy owners’ concerns over prescription reimbursements.
Meanwhile, the board unanimously approved an increase in average SHBP premiums for only the third time in the last seven years. During the last 10 years, premiums have risen only 1.4% per year on average, Louis Amis, the SHBP’s executive director, told board members.
Amis said factors driving the 6% increase taking effect Jan. 1 include general health-care inflation, the continued prevalence of chronic conditions including diabetes and hypertension, and the increased use of anti-obesity medications such as Wegovy.
The SHBP spent $20 million on anti-obesity drugs during the last fiscal year, doubling the $10 million spent in fiscal 2023, he said.
Open enrollment for coverage begins Oct. 16 and runs through Nov. 8. Amis said plan members who do not choose an option will be enrolled in the lowest-cost plan.