Texas congressman urges HHS to reject state's Medicaid-managed care company partnership

Move would harm pharmacies, Lloyd Doggett says

WASHINGTON — A congressman from Texas is urging the Department of Health and Human Services to reject an attempt by the Texas state government to move millions of Medicaid prescription drug beneficiaries into managed care plans.

Democratic Rep. Lloyd Doggett, head of the Texas Democratic Congressional Delegation, said the move would harm small pharmacies that cater to Medicaid beneficiaries and leave many patients without access to pharmacy services by reducing pharmacy dispensing fees to far below the average pharmacy's cost of dispensing each prescription.

In particular, according to a letter to HHS, Doggett wrote that Navitus Health Solutions, the PBM with which the Texas Health and Human Services Commission contracted, required all pharmacies in its Medicaid network to accept a non-negotiable dispensing fee of $1.35 per prescription — 88% below the average pharmacy's cost — despite a state-sponsored study that found the average cost of dispensing a prescription in Texas in 2011 was $11.27.

"Turning Medicaid prescription drug benefits over to private managed care companies will harm patient access and push hundreds of pharmacies out of Medicaid or out of business," Doggett said. "This will deny access to vital prescriptions for many of our neighbors and hurt small businesses that play a vital role in health care."

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