Change provisions relating to pharmacy dispensing fees under the Medical Assistance Act
Summary
LB138 would revise Nebraska’s Medical Assistance Act provisions governing pharmacy dispensing fees paid under Medicaid. The bill sets an interim fee-for-service dispensing reimbursement of $10.38 per prescription for independent pharmacies beginning with the specified fiscal year, while directing the Department of Health and Human Services to complete a cost-of-dispensing survey every two years and use that survey to determine the actual fee. The department would also be required to amend Medicaid managed care contracts so managed care organizations pay a comparable dispensing fee for independent pharmacies.
The bill further establishes different dispensing-fee amounts for other pharmacies and mail-order pharmacies based on annual prescription volume, with lower per-prescription payments for higher-volume pharmacies. It also provides a special $10.38 dispensing fee for pharmacies that are the only enrolled pharmacy within a 30-mile radius, and requires the department to submit reports to the Legislature with recommendations for adjusting dispensing fees to ensure fair and adequate reimbursement. The bill repeals the original section it amends.
Impact
LB138 would change state Medicaid reimbursement policy for pharmacies by setting statutory dispensing-fee amounts, requiring periodic cost surveys, and mandating corresponding managed-care contract changes. It would affect independent pharmacies, other retail pharmacies, mail-order pharmacies, and Medicaid managed care organizations, while also making pharmacy cost data submitted to the department confidential. The bill would alter how the state calculates and updates pharmacy dispensing payments and would require legislative reporting on future fee adjustments.
Sentiment
Based on the bill text and the absence of recorded committee testimony or votes in the provided materials, the measure appears to have been framed as a reimbursement and access issue rather than a broad policy dispute. The structure of the bill suggests an effort to support pharmacy participation in Medicaid by tying payments to cost data and by setting minimum fee levels. However, the bill’s eventual indefinite postponement indicates it did not advance, which may reflect unresolved concerns about cost, implementation, or the appropriate level of reimbursement.
Contention
The main likely point of contention is the level and structure of pharmacy dispensing fees, especially whether the proposed statutory amounts would adequately reimburse independent pharmacies while controlling Medicaid spending. Another possible issue is the requirement that managed care organizations mirror the fee-for-service dispensing fee, which could affect contract costs and administrative flexibility. The bill also distinguishes among pharmacies by prescription volume and geography, which could raise fairness questions for different types of pharmacies and for mail-order providers.