On April 27, TPA joined other Texas pharmacy stakeholders, HHSC Executive Commissioner Charles Smith and senior agency staff to discuss Budget Rider 60 (previously Rider 219). The rider was the result of a pharmacy-led effort during the 2017 Legislative Session requiring the state to study potential Medicaid cost savings.
The Rider requires HHSC to look at potential cost savings that may be achieved through a single fiscal agent (PBM) providing prescription drug benefits. The rider also requires HHSC to look at shifting Medicaid Managed Care pharmacy payments to the National Average Drug Acquisition Cost (NADAC), with a professional dispensing fee based off a recent dispensing fee cost study.
During the meeting, pharmacy shared its belief that a single fiscal agent has the potential to bring much needed transparency, cost savings, and better certainty for the roughly $8 billion biennial Medicaid prescription drug benefit. Of note, consulting firm Deliotte was hired by HHSC to conduct the analysis and provide a report prior to the 2019 Texas Legislative Session.
TPA thanks Brittani Bilse of the Alliance of Independent Pharmacists for setting up this meeting.
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