Texas began its Medicaid managed care overhaul this past spring, and the transition has been anything but a smooth one. The new system is controversial for many reasons, with many patient advocates and health care providers arguing that it will impact patient care. From the perspective of pharmacists, managed care is downright dangerous to their bottom line. Many pharmacists service Medicaid patients as a major part of their customer base--and this new system takes a bite out of their business.
Pharmacy owner Ronald Barrett was featured by Pharmacy Choice and Access Now earlier this year expressing fears about managed care, and what it would mean for his business. This week, his concerns were featured in The New York Times.
According to the report:
Not long after the state rolled pharmacies into Medicaid managed care in March — an effort to save tens of millions of dollars a year — Ronald Barrett noticed something unusual at his store, Oak Cliff Pharmacy in southern Dallas. When he entered a child’s prescription into his computer to see how much he would be reimbursed by CVS Caremark, the managed care plan’s pharmacy benefit manager, he got an error message. A phone call indicated that the prescription had already been filled, at a CVS pharmacy down the road.It turns out that Ronald Barrett’s fears about his pharmacy closing by the end of the year were justified. His experience illustrates the troubles that many community pharmacies face when companies are allowed to set extremely low reimbursement rates for pharmacies in the name of cost savings.
“I asked the child’s mother, ‘Did you have the prescriptions sent over there?’ And she said, ‘No, I don’t even go over there,’ ” said Mr. Barrett, most of whose customers are covered by Medicaid, the state and federal health plan for the disabled and poor. “We called the prescriber, and they said they didn’t know how they got over there either."
Here’s another example:
Another pharmacist, in Harlingen, received a fax from a health plan managed by CVS Caremark rejecting a claim for diabetic test strips with the message, “Please route patient to a CVS pharmacy.”But glitches like these are just the tip of the iceberg when it comes to community pharmacies. They’ve seen their dispensing fees (the cost for the pharmacist to fill a prescription) drop from $7.13 to $1.53 under the new system, which has translated to pharmacists receiving $12.7 million less in dispensing fees during the first month of the new program.
While the state of Texas contends that this magnitude of “cost savings” is what they expected, 26 independent community pharmacies have closed or been sold to retails chains since the managed care pharmacy changes took effect.
To find out more and to take action against managed care for Medicaid, please visit Pharmacy Choice and Access Now.