Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Pharmacy Reimbursement topic
No spam. Unsubscribe anytime.
Committee backs bill to align state employee health plan pharmacy reimbursements with Medicaid
Summary
The House Commerce & Economic Development Committee voted 11-0 to advance HB174, which would require the state employee, teacher and retiree health plan to reimburse community-based pharmacies on the same medication-plus-dispensing-fee model Medicaid uses, supporters told the committee this evening.
House bill 174 would require the state health plan established under the Health Care Purchasing Act to reimburse community-based pharmacies for medication ingredient cost plus a dispensing fee, the same method Medicaid uses, the sponsor told the House Commerce & Economic Development Committee.
The bill’s sponsor said the change is intended to prevent the closure of the fewer-than-60 community-based pharmacies in New Mexico, many in rural areas that are “the only health care providers” locally. “The low cost reimbursements threaten the financial survival of these pharmacies, making it harder for them to serve their communities,” the sponsor said.
Ashley Seaparth, owner of Care Drug in Bloomfield and Aztec, said her Bloomfield location is now the only pharmacy and health-care provider in town. “Right now, as it sits, we’re $30,000 in the hole with just the ingredient cost alone,” Seaparth said. “Under these payers, we can no longer operate like this. This bill will simply make it where we get fair reimbursement within these contracts.”
John Thompson, a registered lobbyist for the New Mexico Pharmacy Business Council, characterized HB174 as narrowly targeted and “a breakeven bill” that aims to allow independent pharmacies to recover their costs. Lex Garcia, executive director of the New Mexico Pharmacists Association, said the measure is also an economic bill: “This keeps their business open for the communities that they serve.”
Colin Bio of the New Mexico Health Care Authority testified the authority was neutral but that the legislation would carry a fiscal impact on the state health benefits fund. “In our fiscal impact report on the state health benefits plan, we do note that this would have about a $1,000,000 impact on the fund,” Bio said, while expressing support for the policy goal of supporting community pharmacists.
Members asked technical questions about the bill’s cross‑reference to Medicaid definitions (for example, the statute’s reference to pharmacies “located in the state or near the state border”) and how administrative costs would be handled for the Public Schools Insurance Authority. The sponsor and witnesses said the community‑pharmacy list and the “near the state border” language were set previously by Medicaid. The sponsor also said contract renewal timing prevents immediate implementation and explained that the state health plan contracts renew on the first of the calendar year.
Representative Matthews moved a “do pass” recommendation and Representative Mason seconded. The committee took a roll call vote; the committee clerk announced a final tally of 11 yes, 0 no and the committee advanced the bill.
The bill now moves to the next committee of referral or the House floor for further action.
