State to begin changes in pharmacy program
The Jindal administration budget that begins Sunday relies on $56 million in savings as a result of a proposed health agency revamp of the Medicaid pharmacy program, the chief of the initiative said Wednesday.
“How we get there is something we can work together on,” Calder Lynch, assistant to state Department of Health and Hospitals Secretary Bruce Greenstein, told a crowd gathered for a public hearing on pharmacy changes.
Lynch said the agency is counting on deriving part of the savings from allowing certain private insurance plans that are providing health care for the poor to start managing the delivery of pharmacy services to their patients. The companies could develop their own rules — within limits, he said.
Other elements, he said, will involve yet-to-be-spelled-out changes in the state’s current Medicaid pharmacy program that would effect the remaining 62 percent of the 1.2 million people receiving the government health insurance.
Lynch said the agency is on track to implement changes sometime this fall.
“You are telling us in a nice roundabout way that we are going to get cut,” said Dean Pellegrin, an independent pharmacist from Houma. “We cannot afford anything less than we are taking now. ... We are barely making ends meet right now.”
Lynch said there is room for savings in the $950 million a year pharmacy program. Efforts to rein in costs have resulted in more reliance on generic drugs and limits on the number of prescriptions, he said, but more can be done.
“We can manage a better program,” Lynch said, as he asked for input from independent pharmacists. “We have to structure a program to achieve those savings.”
Pete Martinez, with the Pharmaceutical Research and Manufacturers of America, said so far all that DHH has put out has been “theoretical” when “specifics matter” in dealing with changes to the pharmacy program that impacts the health of so many.
Martinez encouraged DHH to hold other public hearings once the rules are drafted. “We could come back and convene some type of forum to allow folks not to look at just a concept paper but specific rules,” said Martinez, referring to a policy brief posted on DHH’s website.
He got no assurance from Lynch or other DHH officials that would happen.
Under the initiative, a pharmacy benefit would be added to that provided Bayou Health participants who are enrolled in one of three private health insurance plans in which companies are prepaid a per-member-per-month premium. The companies are Amerigroup, LaCare and Louisiana Healthcare Connections.
Bayou Health is the state’s new private-sector-based health care delivery system for the poor. It relies on companies developing networks of physicians, hospitals and others to coordinate care of two-thirds of Louisiana’s 1.2 million Medicaid recipients, most of them children.
Today, pharmacy services are not included among the Medicaid-covered benefits that the prepaid health plans are responsible for managing.
Medicaid recipients’ prescription drug coverage is handled through a state-run Medicaid pharmacy program. The state-run program will continue to manage the pharmacy benefit for all other Medicaid recipients, including those enrolled in two other private health plans that remain fee-for-service-based.
The other two Bayou Health plans, Community Health Solutions and United Healthcare Community Plan, are enhanced primary care case management networks. The plans process and pay claims using the state Medicaid fiscal intermediary, and pharmacy benefits for recipients in these networks would continue through the Medicaid fee-for-service program.