An insurrection by pharmacists over drug reimbursements for those covered by Medicaid expansion coverage has grown to the point that it’s threatening Gov. Asa Hutchinson’s entire budget.

Pharmacists say the pharmacy benefit manager that oversees reimbursements for prescriptions written for the expanded Medicaid population has reduced payments to the point that many prescriptions are money losers. In response, Sen. Ron Caldwell of Wynne (married to a pharmacist and who has two pharmacist brothers) has introduced legislation to put the pharmacy managers under Insurance Department regulation.


Gov. Hutchinson wants to put off the pharmacy issue. He’s expressed hopes for a private resolution. Controversial issues are tough in a budget session. The Senate has three seats empty to be filled by special elections. There’s some doubt whether the current roster of 32 can muster the 27 votes necessary to continue the Medicaid expansion known as Arkansas Works. That math applies to every money issue, because 27 votes are necessary in the Senate to pass appropriations.

And now comes Caldwell threatening to gum up the entire works. Caldwell wants a commitment from the governor that he’ll put the pharmacy issue on the agenda of a special legislative session, which seems likely later this spring to resolve Medicaid issues.


Caldwell said this yesterday, according to KATV:

Caldwell said he spoke with Hutchinson on Tuesday and said he believes the Governor understands the seriousness of the reimbursement issue, but Hutchinson told Caldwell that he doesn’t want to tackle the issue during the current fiscal session. Caldwell said he told Hutchinson that he wants to see the issue named for a special legislative session and claims to have put the Governor on notice that if he doesn’t call for PBM regulation in a special session, that he’s threatening to not pass the Governor’s budget.

There’s broad support for pharmacists in the legislature. The outcry of independent druggists claiming preferential treatment for chain stores has had an impact. If there’s another side to their story, Hutchinson is past due in getting it out.