Legislative Alert Managed Care Bureaucracy Medicaid
Texas Insider Report: AUSTIN Texas In effort to save money in Texas Medicaid program the state senate recently passed a bill authored by Senator Jane Nelson that is heralded by some as a cost saving measure. Senator Nelson has said our goal is to make sure none of our Medicaid patients are hurt or negatively impacted by anything we do."
Supposedly this legislation that carves in pharmacy services to Medicaid managed care will save the state $51 billion over the next biennium. Sounds great right? If only this were true. Lets take a look at the facts.
A managed care construct for the delivery of pharmacy services actually comes at immense cost to the state. The $51 million dollars in purported savings" actually comes from a premium tax on health insurance passed on to Texas consumers.
Community-based pharmacies provide Medicaid services for only 1 administrative cost while the large pharmacy benefit managers could charge 5-10 times that amount.
Under a managed care system community based pharmacies may be forced out of business by new rules imposed by third-party pharmacy benefit managers. This does hurt Medicaid patients who rely on the trusted personal care of their neighborhood pharmacist.
In an effort to save the state of Texas money officials have made the wrong choice in the senate with regards to carving pharmacy services into Medicaid managed care.
Do the citizens of Texas view a multi-million dollar tax increase as savings? No. Will patients and consumers who rely on their community pharmacy for health care and pharmacy services be negatively affected by this new law? Definitely.
The recently passed senate bill does nothing to improve the efficiency sustainability or quality of the Texas Medicaid Vendor Drug Program. It is simply a short-sighted approach that will cost Texas in the long run.
Common sense solutions to produce savings within the Medicaid Vendor Drug Program include things such as aiming for increased use of generic prescriptions where possible and medication management therapy for patients. House Bill 3678 provides solutions that can produce real sustainable cost-effective improvements to the Texas Medicaid vendor drug program without imposing a premium tax and without the negative effects of a managed care carve-in.
Texas community-based providers have proven to be among the most cost-effective and trusted in the nation. The state legislature should leave the care of patients in their hands and focus on implementing real cost-saving solutions to help reduce the budget deficit.
