More than a year ago, state leaders approved legislation to move Florida’s 3 million Medicaid recipients into a managed-care framework to help close a $3 billion deficit.  That switch -- starting with seniors and the disabled -- began July 1, 2012. 
 
Look for the paper “savings” achieved by the switch to be touted by lawmakers and state officials.  But unless the new program is well thought out, the so-called savings will come at a high cost to patients, health providers and taxpayers in the long run.
 
Florida currently uses a fee-for-service plan, which reimburses health providers based on the services rendered to plan members. For example, if a mother needs a prescription antibiotic to treat her child’s ear infection, she visits the local pharmacy for the medication, and the pharmacy receives reimbursement from the state. 
 
But under the new managed-care system, the State will hand the program over to for-profit pharmacy benefit management (PBM) companies that will receive a set amount of money for administering the program.  The companies then will cut services or trim reimbursements to doctors, dentists, pharmacists and other providers to ensure that they keep costs to no more  than the state provides.  The managed-care companies are in business to make a profit and will do so at the expense of patients and providers. 
 
The same mother described above now will find limited choices regarding where she can get her child’s prescription filled, and the pharmacy will get its reimbursement at the ‘for profit’ companies’ discretion – likely at a rate much lower than the cost of filling the prescription. 
 
As pharmacists and other health care professionals find they can no longer afford to serve Medicaid patients under the new system, they will cut services.  As a pharmacist, I do not want to be forced into the position of denying services to Medicaid patients because a managed-care company will not pay me enough to cover my costs to dispense prescriptions.
 
Medicaid patients are often the sickest, most vulnerable patients we serve.  Typically, the patient might be a frail, elderly lady with limited mobility or a child whose parents cannot make ends meet.  A visit to the pharmacy might be one of the few times they come in contact with a health professional.
 
Losing access to pharmacy services can lead to a decline in patients’ health and much higher health costs in the long run.  One great driver of health costs is lack of what we call medication adherence, which means the correct use of prescribed medicines.  Poor adherence leads to an estimated $100 billion in added hospital costs a year.  The logic is simple: People who do not take needed medicine in appropriate dosages are more likely to see their conditions worsen or end up in the hospital.
 
Patients see their physicians, if they are ill, about once every three to six months, and they may see nurses if they are admitted to a hospital. But they generally see pharmacists more regularly, whenever they get a prescription filled. Pharmacists are health-care professionals who counsel patients regularly.
 
Most pharmacists hold a doctorate degree in pharmacy and drug management. They play an important role in improving adherence by counseling patients to take their medications correctly, warning against harmful drug interactions and helping chronically ill patients manage multiple medications.  A pharmacist’s counseling is certainly more effective than words on a box that is delivered to your doorstep. 
 
Pharmacists have offered the Florida Agency for Health Care Administration (AHCA) a number of ideas that will reduce costs in the Medicaid managed-care pharmacy program without harming patients. 
 
Properly implemented, Medicaid managed care need not be disastrous for patients and providers.  It is up to state leaders to take steps to adopt simple protections and prevent ill-advised cuts that will do lasting harm.

N. Lois Adams is the President/CEO of the HHCS Health Group of Companies which includes Freedom and Cystic Fibrosis Pharmacies and resides in Orlando.

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