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After KanCare, generic drugs a headache for northwest Kansas pharmacists

7/3/2013

By KALEY CONNER

By KALEY CONNER

kconner@dailynews.net

Some northwest Kansas pharmacists have reported difficulties as a result of the state's KanCare transition.

The problem mostly pertains to often-cheaper generic drugs, said Kody Krien, owner of Krien Pharmacy in St. Francis.

"The problem now is 90 percent of what we distribute is generic," Krien said. "The state didn't have anything to say about how (the prices of) generics were calculated, so that's where the problem is."

Krien Pharmacy in March decided to terminate its contract with Sunflower State Health Plan, one of three for-profit companies contracted to administer the state's Medicaid program.

"They have maximum allowable costs on generics," Krien said. "The rates were so low on some drugs, we were losing significant money. ... I had to drop them."

As an extreme example, the pharmacy was absorbing $120 per month in unreimbursed costs for one patient, he said.

Krien said he also contacted the company often, hoping to negotiate reimbursement rates in cases where the pharmacy was losing money.

"For the 10 years I was in business prior, with plain Medicaid, I contacted the state on pricing issues twice -- two times in 10 years," he said. "I contacted Sunflower in the first month for probably 10 claims."

The pharmacy still is contracted with the other two managed care organizations -- Amerigroup Kansas Inc. and United Healthcare Community Plan of Kansas. The business has not had significant difficulties with the other two companies, Krien said, noting most of his customers on Sunflower decided to change providers.

James Hampton, owner of BisonRX Compounding & Therapy in Atwood, said the pharmacy has experienced some challenges regarding reimbursement for durable medical equipment, such as walkers and other assistive devices.

"The biggest problem that we had was with durable medical equipment, initially getting good information on those reimbursements," he said.

Overall, he said the pharmacy has not been hit too hard by the Medicaid changes; staff is waiting to see how the KanCare program affects the business long-term. The pharmacy is contracted with all three Medicaid policies.

"I don't have too many complaints about the program," Hampton said. "Anytime you make a change on state level like that, it's hard to get issues squared away."

Though the pharmacy is not always reimbursed at cost for providing the medical equipment, Hampton said, it's a service he will continue to provide as long as possible.

"It's difficult in our remote areas because some of our patient clientele is not able to go to the nearest other location, and in our case it's 30 miles away," Hampton said. "In our particular situation, we have Prairie Development Center here ... so we feel compelled to take those plans.

"Those are people in our community. We need to serve them the best we can."