Groups unsure on drug plan changes

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Louisiana’s health agency is counting on saving $56 million in its Medicaid pharmacy program to help balance the state budget but no plan is yet finalized on how that savings will occur.

A top aide to state Department of Health and Hospitals Secretary Bruce Greenstein said emergency rules will be published in September with the changes effective Oct. 1.

Legislators, pharmacy interests and others said they are concerned about the lack of transparency and what they call a rush to make the changes that could have unintended negative consequences on health care unless they are done with caution. Consumer groups worry that drug access will be restricted.

“They are creating an emergency,” said state Sen. Fred Mills, R-New Iberia. “They are rushing this thing way too much.”

Greenstein assistant Calder Lynch said delays will only interfere with the agency’s ability to generate the savings demanded by the budget. The state fiscal year began July 1.

Mills and state Sen. Ronnie Johns, R-Lake Charles, said the administration has talked in generalities about how the budget savings are to be achieved, while they and others are looking for how specific policies would change and how they would impact pharmacists and their clients.

“It’s got to come at the expense of somebody, somewhere,” Johns said. “It cannot be from access by the public and hopefully not at the expense of the provider.”

“How is it going to impact all the pharmacists across the state and that’s an unknown,” said Mills who has been involved in discussions with crafters of the plan.

Mills is a pharmacist and banker. Johns is an insurance agent and pharmacist who hasn’t practiced in 30 years.

If the state is not careful, Mills said, it could lose money from pharmaceutical company rebates while it is trying to reduce costs.

Pharmacy services are the second-largest expense in the Medicaid budget at nearly $950 million annually.

Lynch said the agency is working on putting the final pieces of the plan in place. He said the agency has incorporated suggestions and paid attention to concerns expressed by industry representatives and consumers in a previous series of meetings.

A comprehensive summary of the revamp will be completed and released within the next week or two and after that, the agency will publish emergency rules to implement the changes, Lynch said.

“We have a lot of the pieces together,” said Lynch. “There’s a lot of details we want to make sure we get right. ... It’s getting very close.”

Lynch said savings will be achieved in a variety of ways, including decreased utilization through better management of patient care, using the most clinically effective and cost-effective product on the market, a stronger state prior-authorization program for access to certain drugs and changes to the preferred drug list policies.

Peter Martinez, state senior director for the Pharmaceutical Research and Manufacturers of American (PhRMA), said the health agency should provide a draft of the proposed rules for public comment before its publication.

“We have asked to continue to have discussions,” said Martinez. “We have asked to have more public input into the process. There are a lot of people touched by it.”

Randal Johnson, president of the Louisiana Independent Pharmacies Association, said pharmacy service is something people need to improve or maintain their health.

“The pharmacist is the most-accessible health-care provider we have out there,” said Johnson.

Johnson said pharmacists need to be involved in working with the Medicaid health-care plans to bring about the savings contemplated.

Johnson said there was some indication in a prior meeting that the administration wanted to limit pharmacy participation to the top 80 percent of Medicaid dispensers.

“That would cut out independents,” he said.

At a recent DHH meeting, Johns said those in attendance stressed the need for total access so people will be able to get medications where they want to. In other states, Johns said chain drug stores have been given preference in filling prescriptions.

“We want every independent pharmacy in this state and chain drug store to have equal access to be in the program,” Johns said.

In addition, Johns said another concern involved making sure that pharmacists are fairly reimbursed for the services they provide.