By B. Douglas Hoey, RPh, MBA,
As published in Drug Store News
As states grapple with tight budgets, rising Medicaid costs, and the anticipated expansion of Medicaid following the Supreme Court's decision to uphold the Affordable Care Act, policymakers should consider how community pharmacists can help reduce expenses. In addition, new evidence offers a fresh reminder of the perils of managed care in Medicaid and the need for proper oversight of managed care entities.
Recently, Bloomberg Government released a study of managed-care plans in the nation's five most populous states. It found the plans are delivering substandard care, characterized as "significantly and consistently worse than the national median." It adds that lower quality care can lead to higher health spending, through more costly medical interventions.
This comes on top of earlier questions about Medicaid managed care. The New York Times has drawn national attention to the diminished pharmacy access of Texas patients after a new managed care plan slashed pharmacy reimbursements by some 80 percent, forcing some pharmacies to close in the Rio Grande Valley. Separately, the State of Connecticut banished private insurance companies from its Medicaid program, citing "a diminishing confidence in the value of what they are providing." In the Sunshine State, an examination by Georgetown University's Health Policy Institute of Florida's managed care pilot program found "no clear evidence that the pilot programs are saving money, and if they are, whether it is through efficiencies or at the expense of needed care."
Alternatively, community pharmacists can help reduce Medicaid costs in a number of ways.
Plus, community pharmacies afford patients access to low-cost immunizations and health screenings in addition to receiving their prescriptions.
A state utilizing or implementing managed care into Medicaid should, at minimum, adopt some common-sense steps:
Community pharmacists are committed to being part of the solution to reduce Medicaid costs. Managed-care programs will not deliver the promised savings unless proper oversight is conducted and patient access to quality care is maintained.
Mr. Hoey is CEO of the National Community Pharmacists Association.
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