Despite promises, Medicaid still not paying pharmacists to test for coronavirus

By: - June 29, 2020 1:00 am

Nnodum Iheme, owner of Zik’s Family Pharmacy, outside his store in Dayton’s Wright-Dunbar neighborhood in 2018. Iheme, whose clientele is about 70% black, said Friday coronavirus is afoot in the community but the state still hasn’t told him how he can test Medicaid patients. Photo by Marty Schladen.

As cases of coronavirus spiked alarmingly at the end of last week, a promised program by the Ohio Department of Medicaid to allow pharmacies to test patients was mired in confusion.

On Friday, 987 new cases of the virus were reported in the Buckeye State, a 90% increase over the 21-day average. There was an uptick in hospital admissions as well, while states in the South and West that had undertaken aggressive reopenings reported numbers that were even more dire.

Yet, the Ohio Department of Medicaid failed to meet its promise to enable one of the state’s most vulnerable populations to get tested at neighborhood pharmacies.

In a June 15 presentation to the Ohio Prescription Drug Transparency and Affordability Council, Medicaid Director Maureen Corcoran included a slide that had an entry in boldface. It said, “Beginning next week, pharmacies can bill for COVID-19 testing.”

The press had been asking for months when the health care program for the poor — which currently covers more than 25% of all Ohioans — would start paying pharmacists for the tests. But on Friday, some Ohio pharmacists had received no word from the Medicaid department.

“We have been trying to get some guidance from the department of Medicaid,” said Nnodum Iheme, owner of Zik’s Family Pharmacy in Dayton’s historic Wright-Dunbar neighborhood. “We have not been able to do this ourselves.”

The coronavirus is hitting Iheme’s patients, about 70% of whom are Black, particularly hard. The Washington Post on Friday released a poll that found 31% of Blacks personally know someone who has been killed by the virus. That compares to 17% of Hispanics and 9% of whites.

Iheme was unsurprised with the finding.

“There is no doubt that we have a lot of people who have the disease,” he said, stressing the importance of testing. “If we can know where the numbers are — who is positive — then they can take care of themselves and we should be able to minimize the spread.”

Other pharmacists with somewhat different client bases also said they hadn’t gotten word from the Medicaid department, despite Corcoran’s promises.

Klein’s Family Pharmacy in Cuyahoga Falls serves the broader community there, but it’s made a specialty of serving patients with mental illness. In a text message Friday, owner Barry Klein said he hadn’t received any guidance from the Medicaid department.

Neither had Denise Conway, who owns pharmacies in Danville and Mount Vernon on the fringes of Ohio’s Amish country. Last year, she partnered with the Knox County Health Department to open a pharmacy and health clinic to fill a health care desert created in 2017 when CVS bought and closed the lone pharmacy in town.

“We have not been informed of any ability yet to bill for testing,” Conway said in a text message Friday.

The Medicaid department had little to say about the matter.

“I am working on an answer for you — many of our folks are out today, so I may not be successful, but will keep you posted,” Communications Director Lisa Lawless said in an email.

It appears that some system of reimbursing pharmacists to test the poorest Ohioans for coronavirus is in the works. The Capital Journal obtained a guidance memo from Buckeye Health, one of Ohio’s five Medicaid Managed-Care companies.

“Effective on June 24th, 2020, Buckeye Health Plan will be providing coverage and reimbursing pharmacies for the administrative service of COVID-19 specimen collection,” it said. “The State of Ohio has determined that pharmacies will be reimbursed $23.46 dispensing fee and $0.00 ingredient cost for this service.”

But it’s not clear whether the company has released the memo or how widely it’s been distributed.

Fruth Pharmacy owns 10 stores in Southeastern Ohio and others in West Virginia and Kentucky. Andy Becker, the chain’s director of administration, said he’d received a similar letter from CVS Caremark, a pharmacy-benefit administrator.

But, crucially, nobody has explained to him how pharmacies are to obtain personal protective equipment to conduct the tests and whether they’re expected to buy media and machines to evaluate samples or whether they’re expected to send samples off to be tested elsewhere. 

Those expenses are estimated to far exceed $23 even without counting the time it would take to conduct the tests.

“If we’re not going to be buying the tests, where are we supposed to get them from?” Becker asked.

This isn’t the first instance in which the Medicaid department has fallen short on promises. 

Last year, the General Assembly appropriated $100 million to stabilize pharmacies with a large Medicaid clientele that have been losing money due to meager reimbursements from the program. Distribution of the funds was supposed to start in January, but it has been delayed repeatedly. 

In the same presentation that she promised to start funding testing last week, Corcoran held out the possibility that the $100 million appropriation would be axed as a cost-saving measure. She also floated the idea of cutting Medicaid pharmacy benefits altogether.

Also, the Medicaid department has for months been asked when it will enact a January 2019 law that would enable pharmacists to be paid to consult with patients and help them manage such medical conditions as hypertension and diabetes. It is now saying that will happen in January 2021.

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Marty Schladen
Marty Schladen

Marty Schladen has been a reporter for decades, working in Indiana, Texas and other places before returning to his native Ohio to work at The Columbus Dispatch in 2017. He's won state and national journalism awards for investigations into utility regulation, public corruption, the environment, prescription drug spending and other matters.