The recent announcement that the delivery of prescription drugs to Medicaid and Healthy Michigan Plan patients will continue to be managed by Medicaid Health Plans rather than carving out this benefit to manage separately by the state – which was proposed in the Executive Budget for FY 16, is good for Medicaid and HMP recipients and the state’s long-term budget.
Over the years, health plans have demonstrated a cost-effective management of this benefit and other services in Medicaid. The wisdom of this practice was again reaffirmed by a new national report that was issued today by America’s Health Insurance Plans.
That report found “Our analysis of publicly available data indicates the decision to carve out pharmacy benefits is likely to significantly increase costs for states and the Federal government, which undermines the objective of achieving optimal cost-effectiveness in the Medicaid program.
“Moreover, carving out prescription drugs from MCOs inhibits health plans’ ability to integrate pharmacy and medical benefits, which likely has implications for their efforts to reduce unnecessary hospitalizations and improve overall quality of care through medication adherence, care coordination, and timely provider interventions,” the AHIP report found.
I’ll be providing more information in a follow-up post, but if you are interested in reading the entire report, please find it at the following link: http://www.ahip.org/Report/CompMedicaidPharmCosts/
MAHP’s position that separating out pharmacy care from the rest of a patient’s health care was bad for recipients and taxpayers was supported by the House and Senate Subcommittee on Community Health Appropriations. Our advocacy and the actions of the legislation continue to move us toward integration of care.
The state is planning to rebid the Managed Care program later this year. This decision will enable that process to continue on schedule. Meanwhile, our intent as an industry to address the policy objective, used to justify a “carve out” of the pharmacy benefit, for a common formulary can now be addressed as our commitment.