Texas Insider Report: AUSTIN Texas While media coverage of the Texas Legislature has focused primarily on budgetary issues & affected industries little has been said or written about the role of community pharmacies within the states Medicaid program. Unfortunately there are some who feel that changes to Medicaid require turning some pharmacy services over to managed care which takes management of the vendor drug program out of the hands of the Health & Human Services Commission and places it in the hands of pharmaceutical benefits managers or health maintenance organizations.
This adds unnecessary additional layers of bureaucracy between local pharmacy service providers and the state.
In Texas citizens are rightfully concerned about the state of our economy which is largely defined by the massive $13 billion to $24 billion budget shortfall that literally affects every segment of government and society. The topic has dominated the discussion in Austin as elected officials have worked to cut the budget while prioritizing programs and services that are critically important to the public.
Current misguided proposals would allow large companies to serve as brokers administering benefits to nearly three-fourths of Texas pharmacy service providers leaving 20 percent to 25 percent under the current fee-for-service system.
Maintaining two divergent systems would result in increased administrative costs and would hurt community pharmacies that often represent the frontline for patient care. The increased bureaucracy would lead to duplication of
services doing nothing to reduce costs or to deliver meaningful reform to Medicaid.
Most practical people agree that Medicaid requires real meaningful changes as the current trajectory of the program is unsustainable. Health and Human Services accounts for a third of Texas budget and there is simply no way to get the states fiscal house in order without addressing Medicaid. Texans should expect that any changes to the health care system preserve quality and affordable health care and pharmacy services while also offering a sensible approach to curtailing rising health care costs.
Unfortunately another poorly conceived element of the current Medicaid discussion is the proposed cuts that reduce patients provider choices limiting their access to essential prescriptions and other services.
For instance pharmacies which have experienced a 6.23 percent overall cut in Medicaid reimbursement rates in just the last six months potentially face an additional $1 reduction in dispensing fees equating to an 11.86 percent reduction in reimbursement from current levels and a 17.43 percent reduction in reimbursement since Aug. 31 2010. Needless to say this would devastate community pharmacies that often serve as both health and social hubs of rural and urban communities forcing many to close their doors.In addition to the severe cuts in reimbursement rates that are being discussed some legislators have even proposed cutting dispensing fees by as much as $2 which would result in local pharmacies losing money on more than 50 percent of transactions involving the 200 or so brand-name drugs on the market.
Clearly significant changes including cuts need to be made but current proposals are extreme and would destroy community pharmacies jeopardize Medicaid services and lead to significant job losses.Fortunately common sense legislation has been proposed that ensures Texas continues to have strong community pharmacies and reforms the states Medicaid pharmacy program. Rep. Fred Brown R-Bryan-College Station and I along with other colleagues have come together to author HB 3678 which preserves choice and access for patients while mitigating the impact of the current budget shortfall.
The bill provides potential Medicaid savings of more than $70 million by providing sustainable home-grown solutions. It achieves among other cost-saving measures significant savings in the pharmacy program through
increased utilization of generic medications preserves a doctors ability to prescribe the medication that is in the best interests of the patient and maintains pharmacy services within Medicaid.
According to Dr. Ray Perryman an economics researcher the move to managed care combined with other proposed changes to Medicaid could lead to closure of more than 700 pharmacies causing the loss of 42000 jobs and elimination of $3.1 billion in economic output.
Simply put HB 3678 allows us to provide high-quality pharmacy choice and access while addressing our fiscal challenges in a pragmatic way. We must make sure that community pharmacies which are essential to Texas health care system society and economy are able to continue to provide critical services and care to the citizens of Texas.
Time is running out and I would encourage all Texans to contact your state legislators and urge them to push for and support passage of House Bill 3678.State Rep. Ron Reynolds from Houston represents Texas House District 27.
