Recent articles in The Advocate have highlighted the ongoing effort by the Louisiana Department of Health and Hospitals to transfer Medicaid pharmacy services from a traditional fee-for-service system administered by the state to the health plans operating under Bayou Health.
While seeking new approaches to coordinate care for Medicaid recipients is important, the proposed rules currently being developed by DHH could put vulnerable patients at risk, as they would allow a weaker standard of patient protection than is allowed in private-sector plans.
New laws passed by the Louisiana Legislature in 2011 and 2012 and signed by Gov. Bobby Jindal protect insured patients by providing a balance between the need to address increasing budget considerations and patient safety. DHH’s proposal indicates that those protections, which were designed to curb overzealous rationing of care under prior authorization and step therapy schemes, could be rolled back, allowing insurers to create additional roadblocks to patient access to medications.
The aim of integrating benefits should be to increase patient adherence to prescribed medicines, thereby improving the quality of health outcomes and reducing overall medical costs. DHH’s proposed rules allow more limitations on coverage for medicines and could actually increase long-term health costs. Harvard research found that limits on the number of Medicaid prescriptions reimbursed for chronically ill elderly and disabled people resulted in a 35 percent reduction in the use of clinically essential drugs and a 200 percent increase in the use of medical services such as skilled nursing facility and emergency mental health services, exceeding the cost of medicines.
We would encourage DHH to include in their rules guaranteed access to a range of prescription medications, provide for a process that allows open meetings and public feedback into the creation of preferred drug lists, and a transparent review of all formulary management tools employed by insurers. We also support public review of those proposals by the Louisiana Legislature and encourage the appropriate committees of jurisdiction to hold oversight hearings on the rules before they are finalized.
Matthew Bennett, senior vice president
Pharmaceutical Research & Manufacturers