In my last blog, I indicated our pleasure in the Administration’s reversal of the proposed carve out of the pharmacy benefit in Medicaid managed care. As noted in the publication released by AHIP on April 1st, (http://www.ahip.org/Report/CompMedicaidPharmCosts/) the majority of Medicaid beneficiaries are enrolled in health plans across the country and enrollment continues to grow as states increasingly come to rely on them to provide an array of coordinated benefits and services.
In Michigan, the combined enrollment in Medicaid managed care between traditional Medicaid and the healthy Michigan program is over 1.6 million Michigan citizens and will continue to grow as the Healthy Michigan enrollment increases.
Based on all reports, we know that Medicaid health plans are in the best position to meet Medicaid beneficiaries’ primary, acute, chronic and long term care needs and to ensure they obtain services in a timely manner. From our experience in Michigan we know that Medicaid health plans provide:
- Integrated systems of care that promote access to necessary services and improve health outcomes.
- Tailored clinical and care management strategies that improve quality of life.
- Support for adhering to clinical treatment regimens, such as taking medications as prescribed.
- Assistance in coordinating and traveling to medical appointments.
Importantly, retaining the pharmacy benefit will continue to enable Medicaid health plans to use a variety of benefit management practices that improve beneficiaries’ health and well-being, including:
- Pharmacy data providing health plans critical beneficiary information on a timely basis
- Improving patient treatment compliance
- Identifying a beneficiary’s chronic condition and initiating coordinated treatment
- Alerting the beneficiary and physician to potential adverse outcomes
- Ensuring the most clinically appropriate treatment is being delivered
I think all would agree that this is a good thing. Rather that “chasing” pharmacy rebates for short-term financial gain, as would have been the objective of a “carve out,” the focus on managing the pharmacy benefit for the well-being of each beneficiary will continue to be our prime objective.
And did I mention that all research conducted over the past years continue to conclude that carve-in of Pharmacy benefits saves taxpayers up to 14% of costs compared to a “carve out” approach. Integrated managed care is a win-win program, a win for patients and for taxpayers. Let’s build on its success and bring addition integration into focus.