Groups seek legislative intervention on Medicaid rules

Independent pharmacists and prescription drug companies are calling for legislative review of new Medicaid rules they contend could limit patient access to needed medicine and put some drugstores out of business.

On Wednesday, Louisiana Independent Pharmacies Association and Pharmaceutical Research and Manufacturers of America officials said it’s time for the legislature to step in.

The state Department of Health and Hospitals is relying on balancing its budget in part by making the pharmacy program changes.

PhRMA contends the latest rule establishes a bias toward insurance companies over patients and their physicians by omitting patient protections.

Dr. Rodney Wise, state Medicaid program medical director, disagreed. “The whole purpose of this is still patient-centered,” Wise said.

DHH has been “open to feedback from providers ... We are still meeting with providers,” he said. He said he could not say whether there would be changes.

The groups’ concerns relate to emergency rules that:

• Change the manner in which pharmacists are reimbursed through the traditional or “legacy” Medicaid health insurance program run through the state and
• Establish guidelines as private insurance companies who do Medicaid business add drug coverage to their benefit plans Nov. 1. That rule affects Medicaid recipients for whom the state pays a health insurance premium under the Bayou Health program.

Independent pharmacists have been protesting the reimbursement change which went into effect in September, claiming DHH relied on flawed data.

Association President Randal Johnson said a new survey by the group shows that instead of the 3 percent savings DHH had said it was after, the change actually translates into greater than an 18 percent reduction to pharmacies’ bottom line.

“When you have a 17 percent, 18 percent, 30 percent reduction, our pharmacies are having problems,” Johnson said. If they go out of business, then not only Medicaid recipients will suffer, he said.

Wise said the drug pricing is based on average costs based on pharmacy surveys done by a contractor — some pharmacies fare better than others.

Details are lacking as drug coverage is transferred to private insurance companies, PhRMA Deputy Vice President for State Advocacy Tara Ryan said. “What is it they are planning on passing on to patients ... We really don’t know.”

Ryan said there needs to be access to a range of prescription medicines.

Wise said the national lobbying group’s membership is worried about the use of more less-costly generic drugs. He said there are protections so Medicaid patients are not deprived of medicines they need, including an appeals process.