Medicaid Managed Care: Prescription Drugs

The Texas Tribune reports that prescription drugs will be a part of Medicaid managed care as it expands across the state. Pharmacists, who probably will see reimbursement cuts, object. An excerpt:

“I am totally scared to death,” Louis Rumsey, a pharmacist who owns Elam Road Pharmacy in South Dallas, told a joint committee of Texas House and Senate members on Wednesday. Rumsey, who is making plans to sell the pharmacy over the managed care changes, said 85 percent of the patients he serves are on Medicaid, and that the majority are asthmatic patients who receive specialty medication that isn’t available in most chain drug stores or other pharmacies.

Lawmakers approved carving prescription drugs into managed care last legislative session, at the same time that they expanded managed care into many communities that didn’t already have it. Under managed care, Medicaid recipients choose an insurance plan from a list of approved companies contracted by the state. The state then pays a set fee to those insurance companies for each Medicaid patient’s coverage. Metropolitan areas, such as Harris, Bexar, Dallas and Travis counties, have used managed care plans for years. The expansion extends managed care plans to 3.3 million Medicaid enrollees.

Health and Human Services Executive Commissioner Tom Suehs said that with the managed care expansion, it remains essential that every “person who needs this prescription is getting it.”