NCPA shares suggestions for Medicaid managed care rule with CMS

ALEXANDRIA, Va. — As the Trump administration reviews policies in the Medicaid managed care rule, the National Community Pharmacists Association shared with Seema Verma, administrator of the Centers for Medicare and Medicaid Services, a list of provisions it hopes will be included in the rule.

“Independent community pharmacists are proud to play a vital role in the Medicaid program as the backbone of its drug benefit,” NCPA wrote. “Local pharmacists provide expert medication counseling and other cost-saving services that help mitigate the estimated $290 billion that is spent annually as a result of patients who do not adhere properly to their medication regimen. More than any other segment of the pharmacy industry, independent pharmacies are often located in the underserved rural and urban areas that are home to many Medicaid recipients.”

NCPA pointed to such benefits that come from pharmacists’ services as preventing high-cost downstream medical intervention that can cost the Medicaid program a lot of money. The organization urged Verma to keep the rule’s provision that requires states to create and enforce network adequacy standards — time and distance requirements — for such providers as pharmacies.

“Access to pharmacy care services and prescription medications play a critical role in managing chronic conditions and staving off costly downstream medical interventions,” NCPA wrote “Requiring appropriate access standards and the enforcement thereof is essential particularly in the Medicaid program given the fact that many beneficiaries may rely on public transportation or live in a very rural area with limited access to transportation.”

The organization also voiced its support for a provision in the final rule that would require managed care organizations to meet Medicaid fee-for-service standards regarding the availability and prior authorization of covered outpatient prescription drugs. Additionally, NCPA called on CMS to adivse states that managed care organizations must use fee-for-service Medicaid pharmacy provider reimbursement rates as the minimum reimbursement.

“Medicaid fee-for-service pharmacy reimbursement is now required to be based on pharmacy acquisition cost plus a reasonable cost of dispensing the medication,” NCPA wrote. “Any reimbursement metric that goes below this standard is likely to leave many pharmacy providers “underwater” on the medications that they dispense.”

The final rule is set to go into effect on July 1.

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