Rio Grande Valley pharmacists say a move to a managed-care health system in the Texas Medicaid program will have a devastating impact on patients and small businesses.
Changes will begin March 1, but many health-care providers still have a lot of unanswered questions, pharmacists said.
Rather than pharmacies providing prescription drugs directly to low-income patients, persons in the Medicaid program will have to get prescriptions filled through a managed-care company, members of the Rio Grande Valley Independent Pharmacy Association said Friday.
“On March 1, pharmacists are going to take the worst hit of any profession that deals with Medicaid,” said Nario Cantu, whose family owns Cantu’s Pharmacy in Edinburg and Pharr.
Representatives of pharmacies, nursing homes, doctors’ offices, hospitals and clinics or anyone who may be a provider of services to the Medicaid program attended a program Friday at Marine Military Academy in Harlingen to learn about the coming changes.
“As part of the move to managed care, pharmacies will see as much as an 80 percent reduction in reimbursement for filling Medicaid prescriptions,” RGVIPA said in a statement.
“If the reimbursement rates are not increased to be more fair and equitable, many pharmacies in the Valley … could close their doors, resulting in reduced access to vital medications and pharmacy services by Medicaid recipients and other Texans,” RGVIPA said.
But a spokesman for the Texas Health & Human Services Commission defended the coming changes.
Joe Vesowate, deputy director of managed care operations for the agency’s Medicaid and CHIP Division, said he was on hand to explain how the system will work.
“We came down here today, meeting with providers, clearing up any confusion,” Vesowate he said.
“We’re offering them contracts, working with them on contract issues and making sure that they have the opportunity to have the best information available.”
Big health care providers like Valley Baptist Health System, CVS Pharmacy and others have already been going through training to adapt to the new Texas Medicaid system, Vesowate said.
“They’ve been getting ready by doing that, doing the things to do when you change from one system to another,” he said. “There’s still Valley Baptist, there’s still CVS; it’s just that the delivery system is going to go through a managed care system instead of the state paying them directly.”
Cantu said independent pharmacy owners worry that dropping fees for filling Medicaid prescriptions from $6.30 for each prescription to $1.35 each will cause small companies like his to close some of their drugstores and other pharmacies, especially in poorer neighborhoods, to completely shut down.
Legislation that ordered changes in the Medicaid system was pushed by managed care companies and legislators did not have full information before voting on it, Cantu said.
“They were deceived,” he said of Texas lawmakers. “It should not be implemented.
“There’s no way I can make money at $1.35 a prescription.”
One of his stores may have to close down because the cost of rent, utilities and employee payroll may make it impossible to continue operating, he said. Stores in lower-income areas have a high number of Medicaid customers, he said.
“I know of one (local pharmacy) that has 99 percent Medicaid patients,” he said.
Although local pharmacies often deliver prescriptions to elderly, low-income patients, they often do so at a loss, he said.
Large, corporate-owned pharmacies do not provide delivery service, he said. Patients who have no car must either walk to a nearby local pharmacy or rely on delivery service, he said.
Ruben Fonseca, owner of Weslaco Pharmacy, also said local pharmacies provide more service to elderly, low-income Medicaid patients than big chain stores.
Local drugstores are already under intense competition from big chain pharmacies, he said.
Ohio has just decided to drop the program that Texas is now adopting, after using it for five years, Fonseca said.
“Now they are going back to the Texas model,” he said of having Medicaid deal directly with pharmacies that serve Medicaid patients.
“The survival of independent pharmacies is at stake,” Fonseca said of the Medicaid changes.
There should be a moratorium on implementing the Medicaid changes until there is more study, Fonseca said.
http://www.hhsc.state.tx.us/medicaid/MMC/managed-care-tentative.pdf
