Summary: Healthcare costs are continuing to rise. Medicaid continues to expand. What is the best way to regulate
Summary: Healthcare costs are continuing to rise. Medicaid continues to expand. What is the best way to regulate
Medicaid is a social service program that provides health insurance to children and certain needy families and individuals. Medicaid covers certain impoverished families and children who meet strict eligibility requirements.
In 2010, the Patient Protection Affordable Care Act (PPACA) was implemented with provision effective dates extending through 2014. Part of the PPACA is specific to Medicaid and the expansion thereof. Originally, it was proposed to mandate that all states would begin efforts to expand Medicaid in an effort to cover more individuals. Since the initial proposal, a compromise was struck which permitted individual states to either go ahead with expansion or to opt out. The carrot dangled to entice states to participate was that of additional federal funding which would be 100% for the first 3 years and then to scale back progressively.
Many times we think of managed care as it pertains to services of care. However, pharmacy is becoming a key component in the overall managed care arena. The state contracts out its pharmaceutical services to a group that agrees to provide services at a lower cost. Managed care system gets paid the more money they save. Managed care can benefit the patient by reducing the number of opportunities for drug duplication. As with most aspects of healthcare, there is a legitimate concern as to how to apply to behavioral health patients.
The cost of prescription drugs for the Medicaid community are rising at rapid rates along with healthcare costs in general. Currently,
One of the confusing things about Medicaid is that it is under the control of the individual states. Each state has the ability to administer how they see fit within certain parameters. With this being said, different states have different eligibility requirements as well as funding/reimbursement attributes. Examples of this disparity include: one state is $11 per prescription to dispense Medicaid drugs with lower ingredient fees while other states are closer to $2 in dispensing fees with increased costs for ingredients. The big dilemma is trying to achieve some sort of regulation to encourage a level playing field, so to speak. Federal legislation has been proposed but as yet not been approved. Once approved, there is growing concern about not if reimbursement will be cut but by how much.
States have tried to be creative in curbing Medicaid drug costs by instituting preferred drug lists, requiring pre-authorization, requiring manufacture discounts and negotiating rebates and joint-buying programs on a multi-state level. While some of these have been successful, there doesn’t appear to be on solid answer to achieve best practices status.
Will managed care be successful in regard to Medicaid drug costs? Only time will tell.