TPA Testifies in Support of Medicaid Managed Care Reimbursement Floor

On April 25, Texas Pharmacy Association CEO Debbie Garza testified before the House Human Services Committee in support of House Bill 1293 by Rep. Toni Rose. The bill would tie prescription drug reimbursement under Medicaid managed care to the actual acquisition cost, being the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee. This is the same methodology that the Texas fee-for-service program, known as the Vendor Drug Program, adopted in 2016.

“The current system allows PBMs to establish a secret price for the prescription drugs they pay for. That price can vary significantly from pharmacy to pharmacy and bears little relationship to the actual market prices of those drugs,” Garza told the committee. "With over $8.1 billion in taxpayer funds projected to be spent on Medicaid prescription drugs in the upcoming biennium, we deserve more transparency and more accountability than what is currently available."

Click here to view video of the hearing; discussion of HB 1293 begins at 1:32:10; the hearing continues here beginning at 18:18.