DIXON — State Sen. Li Arellano Jr., R Dixon, is calling on the Illinois Department of Healthcare and Family Services to address Medicaid reimbursement issues that he said are leaving independent pharmacies underpaid and at risk of closure. Arellano said the department has the authority to correct problems involving pharmacy benefit managers and should act to ensure pharmacies are not reimbursed below cost. A May 2023 Illinois Auditor General report found more than $100 million in annual discrepancies between payments made by managed care organizations to pharmacy benefit managers and what pharmacies received, along with limited state oversight of contracts and reimbursement rates. The report also found that the state does not verify whether payments align with what pharmacies are actually paid.
“Local pharmacists are sometimes having to do their drug deals at a loss, like literally not even making money on some of them,” Arellano said. “We have found about a hundred million in audits that disappeared, never made it to independent pharmacists, and we can’t account for it.”
Arellano said the issue is especially harmful in rural and underserved areas where pharmacies are often the primary source of medication access, and he warned continued underpayment could force closures and reduce patient access to prescriptions.