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TCPalm: Florida legislators can’t reduce health care costs by allowing more people to get sick

Monday, January 30, 2012

Theresa Tolle: Florida legislators can’t reduce health care costs by allowing more people to get sick

As part of Florida lawmakers’ plan to solve the state’s deficit, they have targeted access and reimbursements to community pharmacies as a way to reduce the cost of Medicaid reimbursements to the poor. However, trying to get a handle on the state’s health care costs by limiting access to pharmacies is like hoping that your team makes a bowl game but cutting the whole first string before the season opener.

Eventually, the Legislature would like to move all 3 million Floridians on Medicaid into managed care pharmacy plans. The problem is that the planned reimbursement rate for pharmacies is projected to drop so low that many of the most popular pharmacies will likely cease refilling prescriptions for Medicaid patients. So you’ve taken the facility that is on the front line of the health care system — the pharmacy — and limited access to it for the segment of the population — the economically disadvantaged — most likely to get ill.

Another aspect of moving Medicaid patients into managed care programs is the push to force patients into becoming mail-order pharmacy customers. If shopping at a mail-order pharmacy works for the patient, then that’s fine. However, for many of our state’s patients who are at high risk for illness, waiting for a prescription to arrive by mail could spell disaster.

A survey released recently by the National Community Pharmacists Association found that “Community pharmacists continue to play a vital role in improving health outcomes while reducing costs.” According to the survey, one of the biggest ways that they reduce these costs is by recommending the appropriate use of generic drugs. In fact, “independent community pharmacies set a new high in generic drug utilization, increasing their ‘generic dispensing rate’ from 69 percent to 72 percent.”

Additionally, their face-to-face patient counseling is not to be dismissed. Local independent pharmacies offer that all-important counseling on the proper use of medications and advise on ways to combat diseases and other common conditions. Disease state management services, including immunization, blood pressure monitoring and diabetes training or medication therapy management service is offered by 78 percent of pharmacies. It’s obvious that these services would be very hard to provide by mail order.

You don’t put together a winning team by first cutting all the most valuable players. You use those players as one of your biggest assets in putting together your game plan. Likewise, health care costs cannot be managed by cutting pharmacies out of the equation. Anyone who thinks that’s to road the long-term savings is shortsighted indeed. Pharmacies aren’t part of the health care problem, they’re part of the solution. Diverting patients away from pharmacies will cost money in the long run, not save it.

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