Louisiana’s state health agency wants to add a pharmacy benefit to certain private insurance networks that are providing health care for the poor.
Three health insurance entities that are paid a per-member-per-month premium payment for Bayou Health participants would start managing the delivery of pharmacy services in their patients’ care plans. Medicaid recipients’ prescription drug coverage is handled through a state-run Medicaid pharmacy program.
The state Department of Health and Hospitals will hold six hearings around the state this month to get input on the planned program expansion. The first meeting is at 6 p.m. Monday at the Clifton Chenier Center Auditorium in Lafayette. The final meeting is at 6 p.m. June 27 in the Galvez Building, 602 N. Fifth St., in Baton Rouge.
Bayou Health — the state’s new private sector based health care delivery system for the poor — went statewide June 1. The Jindal administration initiative involves insurance companies forming networks of physicians, hospitals and other provider responsible for coordination of member health care.
Today, pharmacy services are not included among the Medicaid-covered benefits that health plans are responsible for managing.
“With the first phase of Bayou Health implementation complete, we now look to bring those same principles of coordination and better care management to our pharmacy benefits program,” DHH Secretary Bruce Greenstein said in a news release announcing the move.
The target time frame for implementation is this fall.
Pharmacy services are the second largest expense in the Medicaid budget at nearly $950 million annually. State Medicaid program efforts to reduce costs have included a heavier reliance on generic drugs and limits on number of prescriptions.
Over the last decade, the use of lower cost generic drugs has increased from 51 percent to 67 percent but has leveled off.
“Health plans in other states that effectively manage their own formulary report generic utilization rates consistently over 80 percent,” according to DHH. “There is clear room for improvement.”
According to documents posted on the DHH website, the three companies in what are called “pre-paid” plans already have existing business relationships with a Pharmacy Benefits Manager who has existing pharmacy networks in Louisiana. Amerigroup uses Caremark; Louisiana Healthcare Connections uses US Script; and LaCare uses PerformRx.
DHH intends to ensure that each health plan has an adequate pharmacy network, according to the plan outline. “DHH believes that Health Plans should have the necessary flexibility in contracting and rate setting with pharmacy providers” and “DHH believes that Health Plans should have the ability to manage their own formularies,” the document further states.