Medicaid changes coming
Last Modified: Monday, July 02, 2012 1:41 PM
By John Guidroz / American Press
Local pharmacists and health care providers told state health officials Wednesday that enhancing pharmacy benefits for low-income Medicaid recipients could hurt local pharmacies and people who rely on prescription medication. About 30 people attended the meeting, which was hosted by state Department of Health and Hospitals officials. The changes to the pharmacy benefits are expected to begin this fall, said Calder Lynch, special assistant to DHH Secretary Bruce Greenstein. Dr. Rodney Wise, Medicaid’s medical director, said the Bayou Health prepaid plan — in which the DHH contracts with Amerigroup, LaCare and Louisiana Healthcare Connections — will manage pharmacy benefits for Medicaid recipients. He said using a comprehensive system to manage a patient’s care “tends to improve outcomes” and “the value of the dollar the state is paying for those benefits.” Medicaid recipients in the Bayou Health shared savings plan (Community Health Solutions and United Healthcare) and those not in Bayou Health will see changes in the pharmacy benefit structure, which Wise said will improve access to prescription drugs. The prescription drug coverage for Medicaid recipients is run by a state pharmacy program. The Bayou Health program was implemented June 1 as a way to coordinate care for more than 870,000 Medicaid and LaCHIP recipients. Sen. Ronnie Johns, R-Lake Charles, said he is concerned the changes could put independent pharmacists at risk of losing their jobs. He said people in smaller towns rely on them to get their medication. “They’re hanging by their fingernails to stay open,” he said. “When you put them out of business, you’re affecting people in our state and their access to medical care. We’re a rural state. There’s not a CVS or a Walgreen’s on every corner.” Wise said he understands those concerns, including the lack of oversight of pharmacy benefit managers, or PBMs. He said some PBMs have steered patients away from independent pharmacists to chain retail stores, which DHH does not support. “As we move through this process, we will have contracts where we can restrict and prevent those type of practices,” Wise said. “We have about 1,200 pharmacies in Louisiana, and about half are independent.” Johns said he was pleased that DHH officials stressed transparency, especially since Gov. Bobby Jindal recently vetoed his legislation requiring the Bayou Health program to submit transparency reports to the state DHH. Jindal also vetoed language that Johns and registered pharmacist Sen. Fred Mills, R-New Iberia, put into House Bill 1 which would have provided oversight and transparency over the pharmacy aspect of the program. Johns said the Legislature will spend the next several years analyzing the program and its outcomes. “We will look at how is it working and where are our savings coming from,” he said. “Is it coming on the backs of our stakeholders and our providers? That, in my eyes, is something that is totally unacceptable.” Public response Carol Giles, client services director for the Southwest Louisiana AIDS Council, said the implementation of the Bayou Health program has not been smooth because some providers have not been certified. “It has become more fragmented for our clients in trying to deal with accessing the services they need,” she said. Giles said she wants the pharmacy benefits to be introduced in a way that isn’t confusing for people accessing medication. “Some of these are folks without college degrees,” she said. “The one thing they could count on is that their pharmacy benefits would be the same, and now this is being pulled out from under their feet, as well.” Giles said the average person in Southwest Louisiana living with the HIV virus takes six prescription medications each month. Allen Cassidy, owner and registered pharmacist at Cassidy’s Pharmacy in Jennings, said he is worried that the changes will hurt local pharmacists, who are already struggling financially. “Pharmacists should be a little more respected,” he said. “I think we have come to the rescue to implement savings to DHH for many years. But the department continues to want to cut us, and it really hurts.”
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