Client News

Orlando Sentinel: My Word: Open managed care to more pharmacies

Tuesday, January 22, 2013

Florida spends more than it can afford on Medicaid services for the poor. To solve the problem, the state is extending its managed-care model of health-care delivery, currently as a pilot program in five counties, statewide.

A Bloomberg study reports that managed-care programs in several states, including Florida, may not save taxpayers money in the long run, because they often deliver substandard care.

When patients experience added burden, they are more likely to refrain from taking their prescribed medications. Compliance decreases, leading to an increase in physician and hospital visits and creating higher overall medical cost to the taxpayer.

Before extending managed care, officials at the Agency for Health Care Administration must fix problems in the pharmacy portion that could derail any planned savings.

But managed-care companies, called pharmacy benefit managers, tend to limit patient choices and their access to certain pharmacies. Since taking over a portion of the prescription-drug program, the PBMs have restricted the network of participating pharmacies, cut reimbursement rates, and directed patients into mail-order programs.

The combination of these actions would be a blow to Florida’s 1,324 independent community pharmacies — and their patients. Without being included in the PBM network, many pharmacies could no longer serve their patients.

Reimbursement cuts would also take a toll, especially on pharmacies that serve large numbers of Medicaid patients. If these businesses are unable to make up revenue lost in the Medicaid program with their privately insured patients, they would have to cut services and employees.

Any retail pharmacy that complies with licensing, professional development and quality-assurance regulations should be able to participate in the managed-care program. An open network would make the maximum number of pharmacies available to serve low-income patients.

AHCA should adopt transparency standards so that the public understands where program money is going. How much is going to local pharmacies for professional services? How much are the PBMs profiting? How much is the state saving?

Community pharmacies provide the kind of high-quality care that can lead to significant savings for health-care programs, and they should not be locked out of the managed-care program.

David Ray is director of pharmacy for Circles of Care in Orlando.

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