By: Assemblyman Tyler Diep on August 22, 2019
Californians across our state, including those in Orange County, who depend on life-saving medications are facing the threat of seeing their access to those medications cut off.
This looming threat is the result of newly enacted Medi-Cal reimbursement rules, adopted in Sacramento, that slash reimbursements to community pharmacies that serve as a key link between Medi-Cal patients and the medications they need to survive. In total, the California Department of Health Care Services seeks to cut reimbursements by $67 million a year. But in addition to those cuts, the department has also announced that it plans on retroactively going after another $36 million in previous reimbursements.
This isn’t a theoretical threat, and Orange County faces some of the direst consequences. In the 72nd Assembly district that I represent, there are a total of 91 independent community pharmacies with more than 1,000 pharmacists and a population of nearly 470,000.
Squeezing off this pipeline of access to care makes no sense, especially at a time when our health care challenges continue to grow in Orange County. Out of a countywide population of 3.1 million, about 16 percent of those over 18 were diagnosed with mental illness in 2016. Nearly 11 percent of our county’s population has actually received some form of mental health services in 2016.
We are seeing a growing number of homeless on our streets, many suffering from mental illness or substance use disorder. Their recovery depends on receiving anti-psychotic drugs and other medicines as part of a regular treatment program. What’s more, nearly 7.3 percent of our residents were diagnosed with the HIV virus in 2017, and nearly 13,400 people were diagnosed with cancer in 2014.
With fewer places to receive their specialty medicines, the risk is obvious for the most fragile and vulnerable, including their families, who are dealing with these health concerns. It will create a domino effect. More sick people will get sicker and end up at hospital emergency rooms, which are already straining to meet demand, further driving up the cost to provide care. More people suffering with mental health challenges, including the homeless that are part of the everyday landscape, will end up without the care needed to stabilize and recover.
These cuts are a threat to community pharmacies, which are often the primary source for specialized medications to address diabetes, cancer, HIV, heart disease, behavioral health and a range of other issues. It takes extra time and attention to provide these medications, as well as ensuring that patients are following proper procedures and protocols. I believe these providers want to continue carrying out their commitment to their patients. But many of these pharmacies, which are already losing money due to low reimbursement rates, will be faced with the terrible choice of stopping service to Medi-Cal patients or closing their doors.
We know that greater access to health care is not just the right thing from a compassionate approach; it also makes the most fiscal sense. Keeping people well or managing their conditions helps to keep health care costs down. Five million more Californians have health insurance coverage now, either through private options or through Medi-Cal, compared to the number of insured in 2010. That coverage holds the promise of saving lives and personal finances. But that promise of security only holds meaning if there is genuine access to care, including medications that patients need to keep themselves away from the hospital or the doctor’s office.
It’s not too late to head off this disaster. The Medi-Cal rules, adopted by the Jerry Brown administration in response to 2016 federal regulations, are punitive and don’t make sense. Gov. Gavin Newsom has made it clear that he wants to expand and protect California’s health care safety net. An effective way to do that is to roll back these punitive rules and allow pharmacies to continue their role in ensuring that there is true access to health care in Orange County and across our state.
Assemblyman Tyler Diep, R-Westminster, represents the 72nd Assembly District in Fountain Valley, Garden Grove, Los Alamitos, Seal Beach and Westminster.