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Sunshine State News: Small Pharmacies Seek Stake in Medicaid Changes

Tuesday, July 19, 2011

Owners fear being shut out of new networks lawmakers say bring cost savings
By: Gray Rohrer | Posted: July 19, 2011 3:55 AM

Small pharmacy owners are continuing to speak out against the state’s Medicaid reforms they say favor large chain stores and will push them out of business.Members of Pharmacy Choice and Access Now (PCAN) gathered Monday outside Economy Drug Store — a small, independent pharmacy — in Tallahassee to decry the new Medicaid changes, which — pending federal approval — will move Florida’s 2.9 million recipients into managed-care plans over two years beginning in 2012.Republican lawmakers passed a sweeping Medicaid reform package earlier this year, which transitions the program from a fee-for-service delivery model to a managed care program, in which health plans and service providers are selected for 11 different regions around the state.

PCAN presser

PCAN members Michael Jackson, executive vice president of FPA, left, and Bill Mincy, vice president of business development for PPSC (right), speak out against state Medicaid changes

PCAN members are worried the cost-saving measures included in the reforms will push health care providers to rely on chain drugstores and pharmacies as part of their health care plans.

One of the biggest objections they have to the cost-cutting Medicaid changes is a requirement that providers use a mail-order system to get drugs to patients.

“The business that my family has owned for more than five decades is in serious danger of having to shut our doors due to new laws that do nothing to save costs in Medicaid and needlessly ship jobs to out-of-state mail order companies,” said Alexis McMillan, an Economy Drug Store pharmacist.

Pharmacy owners also doubt that mail orders will generate savings, and complain that Florida’s heat could render useless some medications that need to be refrigerated. The individual attention to a patient provided by a local pharmacy would be lost in the changes as well.

“Mail order is not good medicine, that’s the message that we’re trying to do. We want to make sure that patients have the right to choose the pharmacy of their choice instead of those selected by a state agency or by a health plan that does not have that face-to-face contact,” said Bill Mincy, a PCAN member and vice president for business development for the PPSC.

Yet state GOP lawmakers, pressing to reform a program that takes up nearly 30 percent of the state budget, were keen to include cost reductions like mail-ordering drugs in their reform package. Medicaid expenditures amounted to $21 billion last year, although more than half of it was paid for by federal dollars.

Sen. Joe Negron, R-Stuart, who helped write the reform package, has stated that the new law will save the state $1.1 billion in the first year, with added savings in subsequent years as the transition to managed care takes place. He said he recognizes the value small pharmacies bring to patients, but they must adapt to the new managed care system.

“I think our community pharmacies provide a valuable service to Florida, especially in the rural areas, and I have every expectation that they’ll be able to compete for their business,” Negron said.
PCAN members say they simply want to be included in the new provider networks that will be a part of the transition to managed care.“When we have a pharmacy provider here in the state of Florida, they’re licensed by the state, they can provide quality, valued-added services that can do the kind of things that a pharmacy needs to do to provide access, lower health care costs and have a very good patient safety record — they should be allowed to participate in the program,” said Micahel Jackson, PCAN member and executive vice president of the Florida Pharmacy Association.But, already rebuffed by lawmakers, small-pharmacy owners are now lobbying the Agency for Health Care Administration, the state agency tasked with implementing the Medicaid changes. AHCA must submit a waiver request to the federal Center for Medicare and Medicaid Services by Aug. 1, and federal approval must be given before the wider transition to managed care can take place.“The agency is under the gun, as you know, to implement what the Legislature told it to do. They have an obligation to adhere to those principles provided to them by the Florida  Legislature. But we do believe that the agency has some flexibility in how it’s designed, and we hope that they utilize the full extent of that flexibility to write a state plan amendment that would really benefit the patients of the state of Florida,” Jackson said.
Negron said there were already enough provisions in the Medicaid reforms to ensure the local pharmacies will be able to be a part of the service provider networks.
“I don’t think any special preferences are necessary. I think they bring value to the table with increased patient involvement and that’s their selling point and they’ll be able to compete,” Negron said.

Reach Gray Rohrer at or at (850) 727-0859.

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