California Pharmacists Association and California Medical Association Files Federal Lawsuit Against Department of Health Care Services

SACRAMENTO, Calif.--(BUSINESS WIRE)--In what is a clear violation of law, California Department of Healthcare Services (DHCS) has repeatedly denied the California Pharmacists Association’s (CPhA) and the California Medical Association’s (CMA) requests for information regarding the state’s plan amendments that were submitted to the Centers for Medicare & Medicaid Services (CMS) in June. On Friday, CPhA and CMA joined together and filed a suit against DHCS to obtain the information.

“It is common sense that if patients do not have access to physicians and cannot afford their medications, they end up in the emergency room. That means patients are sicker and the health care system will pay more to treat them.”

“We are frustrated with the State’s ‘hide the ball’ tactics and repeated refusal for transparency in their communication with CMS,” said Jon Roth, CPhA CEO. “These cuts will have a serious impact on patient’s access to critical medications, pharmacist services and physicians – they owe it to all Medi-Cal patients to be open with our requests.”

The California Legislature passed and Governor Brown signed AB 97, which included a 10 percent reimbursement rate cut for physicians and pharmacists, a limited number of physician visits for patients (seven) and mandatory patient co–payments on physician visits and prescription medications.

Federal approval must be granted before the state’s plan amendments can be approved. The state is required to submit underlying documents to CMS clearly documenting that access to care for Medi-Cal patients would not be impacted by the state’s plan amendments.

Because California Medi-Cal rates are already extremely low and many prescription medications are reimbursed at breakeven, many providers cannot afford to participate. The co-payments and arbitrary limits on services will create additional barriers for sick, vulnerable patients seeking care, and ultimately will force them to delay care or use emergency rooms for basic services.

“We’re joining together with our partners in this suit because we believe that access to care is a crucial component of making health care reform in California a success,” CMA CEO Dustin Corcoran said. “The state is trying to find a short term budget solution by cutting access to care for the poorest and most vulnerable Californians.”

CPhA’s Roth agrees, “It is common sense that if patients do not have access to physicians and cannot afford their medications, they end up in the emergency room. That means patients are sicker and the health care system will pay more to treat them.”