As the date approaches this week to move Medicaid pharmacy services to managed care, community pharmacists continue to express their alarm.
After filing a federal lawsuit Feb. 17 to delay the managed care implementation, TrueCare Pharmacies states via its website that the changes could cause serious repercussions for community pharmacies across Texas .
TrueCare, based in Austin, is an organization that brings together independent pharmacies through a cooperative business model. They advocate for independent pharmacies across the state.
Medicaid managed care allows individuals to choose their health plan and doctor, and is expanding statewide starting in March.
After the transition, pharmacies will be reimbursed through health plans rather than the state, as they do currently.
“Clearly we harbor very serious concerns,” Texas Pharmacy Association representative Michael Wright of Austin said. Due to the lawsuit, TrueCare representative John Heal referred media calls to the Association.
For some independent pharmacies whose business is mainly made up of Medicaid participants, a drop in reimbursement could make it difficult for them to stay open, and patients dependent on a single pharmacy would have to go elsewhere for their prescriptions, Wright said.
Currently the state provides an average $6.50 reimbursement for the pharmacies’ dispensing fee, and once they start working with for profit pharmacy benefit managers, or PBMs, that reimbursement could drop, Wright said.
As the deadline is set to arrive Thursday, pharmacy advocates continue to worry about the move’s repercussions.
“We’re going to lose some stores,” Wright said.
However, Charles Cote with the Pharmaceutical Care Management Association, said that those fears “not a valid concern.”
Cote said he couldn’t give a general reimbursement rate used by PBMs since each contract with a pharmacy is different.
While Wright said that an estimated 1,000 independent pharmacies could be adversely impacted out of the 1,700 to 1,800 independent pharmacies statewide, Cote said there were no indications that there would be numerous closures of independent pharmacies.
“There has been no evidence to suggest that will happen,” Cote said.
Although pharmacies will have to lower their prices to make them more competitive, Cote said the move will also save the state millions of dollars.
So far the Texas Health and Human Services Commission has been the subject of two lawsuits regarding the move to Medicaid managed care, Commission representative Stephanie Goodman said.
American Pharmacies initially filed a lawsuit against the HHSC regarding the transition to managed care Aug. 29, which was later dismissed. They have filed for an appeal, Texas Pharmacy Business Council representative Richard Beck said. ~oaoa.com~