Pharmacists can help reduce Medicaid costs; Urge caution on Medicaid Managed Care
As states grapple with tight budgets, rising Medicaid costs and the anticipated expansion of Medicaid following the Supreme Court’s decision to uphold the Patient Protection and Affordable Care Act, policymakers should consider how community pharmacists can help reduce expenses. In addition, new evidence offers a fresh reminder of the perils of managed care in Medicaid and the need for proper oversight of managed care entities.
Recently, Bloomberg Government released a study of managed-care plans in the nation’s five most populous states. It found the plans are delivering substandard care, characterized as "significantly and consistently worse than the national median." It added that lower quality care can lead to higher health spending through more costly medical interventions.
This comes on top of earlier questions about Medicaid managed care. The New York Times has drawn national attention to the diminished pharmacy access of Texas patients after a new managed care plan slashed pharmacy reimbursements by some 80 percent, forcing some pharmacies to close in the Rio Grande Valley. Separately, the state of Connecticut banished private insurance companies from its Medicaid program, citing "a diminishing confidence in the value of what they are providing." In the Sunshine State, an examination by Georgetown University’s Health Policy Institute of Florida’s managed care pilot program found "no clear evidence that the pilot programs are saving money, and if they are, whether it is through efficiencies or at the expense of needed care."
Alternatively, community pharmacists can help reduce Medicaid costs in a number of ways:
- Drive greater use of low-cost generic drugs. Community pharmacies are already leading the way to maximize the appropriate use of generic medications — the most effective means to lower prescription drug costs without harming patients. Medicaid could save more than $600 million for every 1% increase in generic use. The Massachusetts fee-for-service Medicaid program has the highest generic dispensing rate in the nation, at 79.3 percent. If all other states achieved that rate, the Medicaid program could save $5.14 billion. States may forfeit savings from generic drugs if they rely on mail-order pharmacies owned by pharmacy benefit managers, commonly a part of managed care. PBM-owned mail pharmacies dispense generics 10% less often than local pharmacies, partly because they receive large manufacturer rebates for dispensing brand-name drugs.
- Incorporate medication therapy management. Pharmacists provide one-on-one attention and prescription counseling to Medicaid beneficiaries with often-complicated health conditions and medication regimens. One percent of all beneficiaries account for 25% of expenditures. Expanding the use of low-cost MTM programs can help make a much greater dent in the $290 billion annual cost to the health system of poor medication adherence. Plus, community pharmacies afford patients access to low-cost immunizations and health screenings, in addition to receiving their prescriptions.
A state utilizing or implementing managed care into Medicaid should, at minimum, adopt some common-sense steps:
- Transparency. Properly implementing aggressive transparency measures into contracts will result in savings that stay in the state, not funneled to an out-of-state corporation.
- Patient choice and pharmacy competition. Allow all community pharmacies eligible to participate in federal health plans to participate in a state plan’s pharmacy network provided that the plan’s costs will be comparable or the same. This also assures that patients have choice and more taxpayer dollars remain in-state at local businesses.
- Ensure fair compensation. While reducing costs, reimbursement must be fair and reflective of all aspects of providing prescriptions to Medicaid patients so that community pharmacies can continue to participate in the program. This should include accounting for Medicaid patients unable to afford their co-pay. In rural communities in particular, an independent pharmacy may be the only one for miles around, and loss of access can be devastating to patients.
Community pharmacists are committed to being part of the solution to reduce Medicaid costs. Managed-care programs will not deliver the promised savings unless proper oversight is conducted and patient access to quality care is maintained.
B. Douglas Hoey is CEO of the National Community Pharmacists Association.
Pharmacist Nick Dorich joins NACDS, NACDS Foundation staff
ALEXANDRIA, Va. — The National Association of Chain Drug Stores announced on Thursday the hiring of pharmacist Nick Dorich to serve as NACDS’ manager of pharmacy care and as the NACDS Foundation’s manager of foundation programs.
Dorich’s hiring follows his completion of the NACDS Foundation Executive Resident program from 2011 to 2012. He will join NACDS’ newly enhanced pharmacy care and patient advocacy department and will report to Alex Adams, NACDS’ director of pharmacy programs. Dorich began his new positions on July 2.
“We are pleased that Nick is joining us to further advance the important work of NACDS’ pharmacy care and patient advocacy department and the work of the NACDS Foundation,” said NACDS president and CEO Steve Anderson. “Nick has been a tremendous contributor to the work of the NACDS Foundation over the last year, proving his dedication and commitment to patient care. As a pharmacist, Nick will bring tremendous knowledge and commitment to both of his new roles.”
In his new role with NACDS, Dorich will work to further advance the redefined efforts of the new pharmacy care and patient advocacy department under the leadership of Kathleen Jaeger, NACDS’ SVP pharmacy care and patient advocacy. The department seeks to advance pharmacy information and research, conduct outreach with NACDS members and with external constituencies — including colleges and schools of pharmacy — and provide pharmacy insights and expertise that contribute to NACDS’ public policy advocacy and communications initiatives.
Specifically, Dorich will provide assistance in the development and execution in efforts to heighten awareness and visibility of the value of pharmacy care. He will also maintain awareness of current pharmacy and healthcare delivery trends and issues, identifying opportunities for collaboration with other healthcare stakeholders.
As manager of foundation programs, Dorich also will manage and execute programs that advance the public health mission of the NACDS Foundation, including charitable giving, education and training programs.
Febreze launches Moms versus Stink contest
CINCINNATI — Febreze has launched a contest for the ultimate sports mom.
Febreze is offering a $20,000 grand prize as a means to send little athletes across the country to sports camp and help fund their athletic experiences. Through July 12, moms can enter the Moms versus Stink contest by simply visiting the Fabreze Facebook page and uploading a photo showing how they are a super sports mom. Once submitted, the top 15 photo finalists will be chosen based on creativity, originality and appropriateness of theme and announced on the Febreze Facebook page. From July 20 until Aug. 1, Facebook fans will have the opportunity to vote on their favorite sports mom within that group of 15, and catapult five lucky moms into the semi-finals. The five semi-finalist moms then will create a video showing how they tackle sports stink with Febreze, everything from spraying down sports uniforms with Fabric Refresher to using Febreze Car during game day. On Sept. 14, fans once again will have the chance to vote for their favorite mom and the title of the ultimate sports mom will be determined by the number of votes each video receives.
The grand-prize winner will be announced on Sept. 24 and will be awarded $20,000 to be used towards admission to their child’s sports camp and the title of Ultimate Sports Mom.
"Anyone who grew up playing sports knows how much time, passion and effort moms put into their children’s games," Procter & Gamble communications manager Jeff Pierce said. "We want to reward those moms and acknowledge their children’s athletic passions through a fun and engaging contest."