West Virginia Managed Care Threatens Pharmacies

PUTT Board Member J.J. Bernabei’s letter in the Charleston Gazette explains why managed care will ultimately raise medication costs and threaten community pharmacy

To the Editor:

CHARLESTON, W.Va. — As West Virginia’s Medicaid program transitions to a “managed care” model, there’s reason to believe the new system could result in a waste of taxpayer dollars and leave the state’s independent pharmacists — and their thousands of Medicaid customers — on the outside looking in.

As the state plans to turn its Medicaid prescription drug program over to three out-of-state managed care organizations, it will likely face two new layers of increased administrative costs from managed care and pharmacy benefit managers who are armed with slick marketing and lobbying campaigns but no proof of cost savings to the state. Ultimately, that will cost the state money and inflate the cost of medications by increasing the role of pharmacy’s middlemen.

Judging from results of managed care programs in other states, the new program will also force pharmacies to accept decreased reimbursement for medications. Since Texas transitioned to managed care in March, roughly 30 independent pharmacies have closed or been sold to retail pharmacy chains. When Kentucky transitioned to a managed care system in November, independent pharmacists experienced an 80 percent reduction in professional fees and draconian cuts to drug reimbursement. The new program in West Virginia will likely have a similar result, forcing pharmacies to close and reducing patients’ access to care and medications.

To provide the state’s Medicaid recipients with the highest-quality care possible and help improve our state’s economy, legislators should keep Medicaid dollars in West Virginia, not ship them to three out-of-state managed care organizations.  Read More…

J.J. Bernabei
Member, Pharmacists United for Truth and Transparency