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Pharmacy Supports Medicaid Managed Care Reform

Wednesday, April 3, 2019   (0 Comments)
Posted by: Brian Sparks
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Late in the evening on April 3, the Texas House Public Health Committee heard testimony on House Bill 3388 by Rep. J.D. Sheffield that address carving pharmacy benefits out of Medicaid managed care. Specifically, this legislation would eliminate the current MCO / PBM model in lieu of a single claims processor approach, which creates an efficient, real-time and transparent system eliminating fragmentation and duplication of functions already contracted by the Health and Human Services Commission. 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.

Among those who spoke in favor of the bill were TPA members Anjanette Wyatt and Louis Rumsey, representing independent pharmacy owners. "There are closures of pharmacies every day because of no reimbursement," Wyatt said. "I didn't say low reimbursement; I said no reimbursement." Rumsey shared a similar story. "Due to decreases in pharmacy provider reimbursements by the PBM, I was faced with overwhelming financial challenges even though I'm filling 50,000 to 60,000 prescriptions a year," Rumsey said. "Taking care of poor, sick children became the most challenging population to serve from a pharmacy business standpoint." TPA CEO Debbie Garza submitted written testimony in support of HB 3388. Thank you to the many TPA members who signed the petition and shared their stories regarding PBM and Medicaid issues. TPA will compile those responses and share them with the House Public Health Committee.

 TPA Member Anjanette Wyatt testifies at the Capitol in support of Medicaid managed care reform.
TPA Member Anjanette Wyatt testifies at the Capitol in support of Medicaid managed care reform.

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