AB 2100 by Assemblymember Wood Preserves Access to High-Cost HIV/AIDS and Mental Health Drugs for Medi-Cal Patients

Wednesday, July 29, 2020

SACRAMENTO—AB 2100 by Assemblymember Jim Wood (D-Santa Rosa), will help California’s most vulnerable Medi-Cal beneficiaries continue to have access to high-cost specialty drugs that treat cancer, HIV/AIDS and serious mental health conditions by helping independent, often urban and rural, community pharmacies remain financially viable. This bill is scheduled to be heard in Senate Health Committee on Saturday, August 1.

“Independent community pharmacies across our state are facing drastic cuts that threaten access to essential life-saving medicines among California’s most vulnerable Medi-Cal beneficiaries – roughly three million people,” said Wood.

In 2019, the California Department of Health Care Services implemented a new methodology to calculate Medi-Cal reimbursement rates for specialty medicines. This new calculation results in independent pharmacies receiving a reimbursement rate lower than what they must pay to acquire the drugs. The result is a retroactive cut of $206.8 million for claims dating back to April 2017 that is currently the subject of litigation, and an annual $107 million cut to Medi-Cal reimbursements.

“For California’s small, inner city and rural pharmacies, fair Medi-Cal reimbursement rates can be the difference between continued operation and closure,” said Wood. “AB 2100 would provide an additional disease management payment to pharmacies based on the additional costs and services associated with dispensing high-cost drugs.”

A recent survey of independent pharmacists in California found that more than 60 percent are being forced to consider closing due to these rules and nearly three-quarters say they may not be able to keep serving Medi-Cal patients or dispensing specialty medications.

“I have spoken with many of these pharmacists and neither of these choices are anything they want to do,” said Wood. “They are often the only pharmacy for miles and are dedicated to supporting their communities, but the severity of these rate reductions may leave them no choice.”

At most risk are those who need access to specialty medications and services, including people who are battling HIV/AIDS, behavioral health challenges and seniors and disabled adults living in long-term care facilities.

“Without these pharmacies, many patients will have nowhere to go, and AB 2100 can help provide a lifeline to the pharmacies and the patients they serve,” said Wood.

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