The Centers for Medicare and Medicaid Services (CMS) recently granted preliminary approval of Texas' waiver implementing a new Medicaid managed care plan switching pharmacy, among other health care services, to a managed-care model. This move would be disastrous to Texas pharmacies, and would hurt the quality of patient care.
Pharmacy Choice and Access Now (PCAN)--a coalition of consumers, local businesses and pharmacists across the nation and Texas committed to preserving quality and affordable health care--believes CMS should reject the State of Texas' proposed Section 1115 waiver now pending before the agency, citing a precipitous decline in reimbursement rates that will force pharmacies out of business, as well as threaten patient services and access to care.
The proposed implementation of the managed care model will drastically reduce reimbursement rates for local pharmacies that fill prescriptions and could force some out of business altogether--and even more out of the Texas Medicaid program. Currently, pharmacies receive reimbursement for Medicaid prescriptions through the Vendor Drug Program regulated by the state and open to all pharmacies. Under the new plan, they will be subject to rates set by pharmacy benefits managers (PBMs) and managed care organizations, for-profit firms that will administer the managed care pharmacy program.
Independent pharmacies across Texas have already begun receiving contracts from at least one PBM that represents an 80% reduction in reimbursement rates per prescription dispensed for Medicaid patients. Such drastic cuts are unsustainable for many pharmacies, particularly those in under-served rural and urban areas where prescription volume is heavily geared toward Medicaid recipients.
Further complicating matters, the managed care model is inappropriate for many segments of the Medicaid population, including the blind and disabled, who rely heavily on special services and counseling provided by pharmacists in addition to prescriptions.
Concerned citizens may sign the Texas Pharmacy Protection Petition at www.rxchoiceandaccess.com.
Medical giant Johnson & Johnson's subsidiary DePuy Orthopaedics recently issued a massive hip replacement recall of 93,000 hip implants. DePuy admits that the recalled hip implants have a failure rate of at least 13%, which means that more than 12,000 people will have to undergo a surgery to remove an replace the defective devices.
Who will pay for these surgeries, each which can cost $50,000 or more? Government programs (like the Texas Medicaid program and the federal Medicare program) already have paid substantial costs to surgically remove the recalled hip replacement parts, and assuming $50,000 for each surgery, the total medical costs of DePuy's hip implant recall could exceed $600 million. DePuy tells patients that these costs should be submitted to the patient's insurance company for payment. In many cases, this will be Texas' Medicaid or Medicare.
(Wow. Just, wow. - promoted by Karl-Thomas Musselman)
As reported in today's American-Statesman, hours into a hearing of the Health and Human Services Committee, Republican committee member Gary Elkins, an eight-term member of the Texas House of Representatives asked,
"What's Medicaid? I know I hear it ... I really don't know what it is. I know that's a big shock to everyone in the audience, Okay?"
Elkins comes to the Capitol from Jersey Village, which lies along U.S. 290, just outside the tollway in northwest Harris County.
The town is named for the Jersey cows once ubiquitous on Clark W. Henry's 1,236 acre F&M Dairy. Clark sold the land for residential development in 1953, and Jersey Village was incorporated in 1956, around the time Elkins was born.
Jersey Village makes up a small albeit privileged fraction of the 135th House District. The 2000 census found 6,880 people living in Jersey Village, 9,498 in scattered random bits that had been annexed into Houston, and 118,089 spread across the vast non-incorporated areas making up the bulk of the district.
In contrast to Jersey Village, which is 82% white, the Houston bits and unincorporated areas are 48% minority. The poor of the district outnumber the entire population of Jersey Village, which enjoyed a median family income of $82,689 in 2000, some 60% higher than the corresponding national figure.
So if your reaction to Elkins' question was, "Does this guy live in a bubble?" The answer is an unqualified "yes."
