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Texas House Members File Important Medicaid Pharmacy Bills

Wednesday, March 6, 2019   (0 Comments)
Posted by: Brian Sparks
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Medicaid Reform in Texas

 

Texas pharmacy supports legislation filed Wednesday by Rep. J.D. Sheffield (R-Gatesville) and Rep. Richard Peña Raymond (D-Laredo) that would bring much-needed transparency and accountability to the state Medicaid and related pharmacy programs.

“Medicaid reform is one of pharmacy’s top priorities for this legislative session because it affects all community pharmacists, whether they practice in an independent setting or in a larger chain,” said Debbie Garza, R.Ph., CEO of the Texas Pharmacy Association. “Our members understand the importance of this legislation for our patients and for our profession.”

HB 3388 and HB 3401 are the result of Rider 60 from the 2017 session, which studied potential cost savings and efficiencies by eliminating the current model, which utilizes multiple pharmacy benefit managers (PBMs), in lieu of a streamlined and transparent single claims processor. The new and innovative model would process pharmacy claims in real time, utilizing a transparent benchmark based on actual drug purchase prices. The change will ensure that the state achieves timely data and maximum transparency in drug prices and avoids costly overpayments to PBMs.

Pharmacists would be reimbursed for the cost of medications based on transparent benchmarks while receiving a Professional Dispensing Fee that bears a relation to true economics. An independent study conducted during the interim found a pathway for state tax savings of $90 million utilizing the new model. In addition, the study said that transitioning to a streamlined system may “increase HHSC’s ability to improve adherence to its PDL and help HHSC identify outcomes based on pharmacy data.”

“I am mindful of the compelling interests of patients, providers and our state taxpayers,” Raymond said. “This important legislation will benefit all three groups by delivering the prescription drug benefit more efficiently with better patient outcomes.”

Pharmacy advocates also believe that by consolidating prescription data into a fully integrated claims system, enormous opportunities exist for an outcome-based care management system.

“Having been a practicing family physician for over 25 years, I know firsthand the important role our pharmacists play in the delivery of quality healthcare in Texas,” Sheffield said. “In rural Texas especially, our pharmacists are our frontline partners in improving patient care and positive outcomes.”

The legislation would ensure that the state receives maximum benefit from drug pricing transparency while creating an equitable reimbursement for pharmacy providers.

The effort is the culmination of many years of hard work by Texas pharmacy advocates. It is also a top priority of all the pharmacy organizations in Texas, known as the Texas Pharmacy Summit, and has received the unanimous approval and support from the group.

“It is good to see key legislators recognize the value of pharmacy in their districts and the state, as well as the important role pharmacists play in healthcare,” said Texas Pharmacy Association President Mark Comfort, Pharm.D. “We applaud Representative Sheffield and Representative Raymond for recognizing the transparency and efficiencies Texas can gain from a single claims processor in the Medicaid program, and the benefits for patients and providers.”

Texas pharmacists are encouraged to contact their state representative and encourage them to submit a request to co-sponsor HB 3388 and HB 3401.


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