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Texas indies decry shift to Medicaid managed care

BY Jim Frederick

If you’re an independent pharmacist trying to make ends meet in the state of Texas, good luck. A shift in the way the Lone Star State pays for Medicaid — as enacted by Texas legislature — is hammering many pharmacies, according to a June 14 report from the Texas Tribune, as reported in the New York Times. And once again, it’s the independents that are feeling the hammer strikes hardest.

The source of their pain was a move three months ago by state government to shift prescription drug coverage for Medicaid patients into a managed care model. Instead of receiving drug benefits directly from the state’s Medicaid program, lower-income beneficiaries are now covered by 1-of-7 pharmacy benefit managers handling Medicaid recipients’ claims, according to the Times (among the PBMs administering those claims is CVS Caremark).

State lawmakers predict the shift of Medicaid pharmacy benefits into managed care will save Texas $100 million in 2012-2013. But the transition to managed care has been a “bumpy” one, the news service reported last week, "with numerous computer errors and miscommunications between the State Health and Human Services Commission, pharmacists and the pharmacy benefit managers."

Since then, the snags that accompanied the shift to the new PBM model seem to have been largely untangled, according to the report. But the longer-term impact on hard-hit pharmacy owners remains.

Why? Pharmacies that serve Texas Medicaid recipients are now receiving "drastically reduced reimbursement rates set by the managed care plans," the Times reported, with average Medicaid dispensing fees dropping from $7.13 to $1.53 under the new plan. With some rural community indies depending on Medicaid for a huge chunk of their prescription business, the predictable result is that mom-and-pop pharmacies are, once again, the canaries in the coal mine.

Some of the canaries already have expired, according to the report. One pharmacy owner in Mission, Texas, told a Texas Tribune reporter he knows of 26 indies that "have closed or been sold to retail chains since the managed care changes."

Independent pharmacy advocates in the state argue that lawmakers could have achieved the desired savings through other means, such as encouraging more generic drug substitutions. But for some owner-operators, the damage appears to already have been done.

If you’re one of them, or if you represent the PBM industry in Texas and want to talk about why the shift to managed care is a positive for the state, please share your thoughts with us. We’d like to hear from both sides.

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Walgreens reaffirms support for National Guard, military veterans

BY Michael Johnsen

DEERFIELD, Ill. — Walgreens last week reaffirmed its support for National Guard and reserve members and their families with the signing of a statement of support by Walgreens chief human resources officer Kathleen Wilson-Thompson.

According to the drug store operator, Walgreens has a comprehensive strategy in place to hire and transition military talent. In addition to working with the Employer Support of the Guard and Reserve, the company is working with numerous veteran service organizations to raise awareness and support for military members, their spouses and qualified veterans. As part of its outreach strategy, Walgreens also announced a new veteran outreach email box available at [email protected] that will serve as a resource to help link potential Walgreens applicants with the company’s military and disability outreach community recruiter.

"We’re proud to be a part of an organization designed to help American employers support the employment and military service of members of the National Guard and Reserve," Wilson-Thompson said. "Transitioning to civilian life is challenging for many returning service members, and it is our hope that we can help provide insight and assistance to help veterans obtain civilian employment."

Walgreens has a long history of supporting American troops and veterans, from providing a store in the Pentagon beginning in the 1940s, to decades of donation and product drives, and extending company benefits to employees called to active service. Under the Walgreens military leave policy, employees called to active service receive their full salary, less military pay, for 42 months from the last day worked. In addition, they have the option of continuing medical, prescription and dental coverage at active employee rates.

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KFF: Americans still cutting corners to avoid rising healthcare costs

BY Michael Johnsen

MENLO PARK, Calif. — Americans still are forgoing or delaying health care on account of the economy, according to the Kaiser Family Foundation, which recently released its May Health Tracking Poll.

One in four Americans reported they have had problems paying medical bills in the past year, and as many as 60% said they have cut corners to avoid healthcare costs.

"The public is most likely to report relying on home remedies or over-the-counter drugs instead of going to see a doctor (38%) and skipping dental care or checkups (35%)," the report read. "Twenty‐nine percent report that because of the cost, they have postponed needed health care; 25% say they have skipped a recommended medical test or treatment; and a similar share (24%) did not fill a prescription for a medicine. Smaller shares report they cut
pills in half or skipped doses of medicine (16%) or had problems getting mental health care (8%) in the past year due to the cost."

And the general consensus is all could get worse before it gets better as healthcare costs continue to rise. Among Americans ages 18 to 64 years with private health insurance, about half (52%) reported that their health insurance premiums have been going up lately, and 28% said this has been a financial burden for them. In terms of deductibles and copayments, about 42% reported that these costs have been rising, and about half of that group said it’s a financial burden, the foundation noted.

When those ages 18 to 64 years with private health insurance are asked which form of healthcare costs personally cause the greatest financial burden, roughly equal shares said health insurance premiums (19%), the plan deductible (18%) and copayments for doctor visits and prescription drugs (16%), according to the report.

To download the report, click here.

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D.Lee says:
Jun-26-2013 02:06 am

Sad to hear that people are cutting corners because of rising health care costs that they are unable to pay. Many people go for home remedies or over the counter drugs instead of going to a doctor. The medical fees, expensive medicines etc are making them to do so. The financial burden of health care is increasing and causing people a lot of problems. https://urgentcareguru.com/clinic/2162

N.CHARLIE says:
Jan-22-2013 07:41 am

I wonder when all these statistics will reach our governments ears, we obviously need some help coping with the rising healthcare costs. These days I'm seriously thinking to pursue a healthcare career, I really want to understand which is the cause for the current healthcare and how could I change this situation.

Kathryn Menefee says:
Jun-27-2012 11:28 am

The reason that healthcare costs continue going up is the expensive and inefficient U.S. healthcare delivery system. The consequences of the fee-for-service model put an unnecessary financial burden on patients and employers and raise the overall cost of healthcare. Read a recent blog by Bob Fabbio about healthcare spending in the US, http://blog.whiteglove.com/what-does-2-trillion-buy-how-about-our-nation%e2%80%99s-healthcare/

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