Community pharmacies in Texas are in danger. With health care access in rural areas already limited in some parts of the state, many Texans rely on their community pharmacist as one of their primary health care providers. But recent changes to the state's Medicaid program have already forced some pharmacies to close, and more will be in danger if we do not act.
Pharmacy Choice and Access Now had the pleasure of attending the Texas Pharmacy Association's 2012 Rxperts Leadership Symposium in Austin with dozens of pharmacists from around the state, many of whom expressed concern about their ability to stay in business. Between the Medicaid managed care shift and low reimbursements even for patients with private insurance, this is a dire time to be a pharmacist or pharmacy owner in Texas.
On pharmacist at the event, Dallas Community Pharmacy Owner Ronald Barrett, expressed his concerns over low reimbursement fees from Pharmacy Benefit Managers (PBMs):
"The reimbursement fees are so low. There is no business in any field, who gets a $1 profit off of a $180 expenditure... There's just no way any business can survive off of that."
He doesn't expect to be in business at the end of this year.
What can you do to help? Visit Pharmacy Choice and Access Now to find out more, and add your voice to those willing to stand up for continued pharmacy care in Texas!
Believe it or not, February is halfway over, and March 1 looms. Many are likely looking forward to March. Perhaps they are college basketball fans, or are eagerly awaiting an extra hour of daylight, and the first day of spring. But for many Texans, March 1 will mean something entirely different. It is the deadline looming for Texans on Medicaid to make the switch to a managed care program. Managed care will be disastrous on a number of levels. For one, as it is currently being implemented, managed care for Medicaid patients in Texas could devastate community pharmacy and dramatically reduce patient access to healthcare for the state's most vulnerable citizens.
Pharmacists are too often ignored when one considers health care providers. Everyone may point to nurses, doctors and physical therapists, but pharmacists are on the front lines of health care. Often they are the provider the patient has the most contact with, particularly those suffering from chronic illness or disabilities. Under the new managed care system, it is estimated that pharmacy provider reimbursements could be cut nearly 80 percent. This reduction would essentially make it impossible for many community-based pharmacies to continue servicing Medicaid patients. At a minimum, important healthcare services could be reduced.
This pinch could be felt especially hard in rural areas in Texas, where access to pharmacy services is already limited, and in areas where there is a heavy population of Medicaid patients. In some cases, pharmacies may be forced to shut down-at a time when unemployment remains high and the economy struggles to recover. Can we really afford to lose more jobs? Similar effects occurred in Kentucky shortly after rolling out managed care for Medicaid, with job losses and an adverse impact on rural economies.
For example, a 2011 study by Texas economist, Dr. Ray Perryman, projected that a move to managed care for Medicaid pharmacy services could lead to the closure of hundreds of community-based pharmacies and the loss of over 42,000 jobs in the state. The negative economic ripple from this could further damage struggling Texas communities. In an article in this week's Brownsville Herald, one local pharmacist argued that he may have to shut down, because his patients rely heavily on Medicaid and he cannot afford to continue.
Pharmacists are worried and patients are worried. With March and managed care for Texas Medicaid patients looming, everyone should be worried. We can only hope that lawmakers may come to their senses before then.
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.
