RE: Medicaid payments
[Disclaimer: As a pharmacist, I do have an obvious bias]
these changes to Medicaid are relatively non-controversial
And completely nonsensical if you really look at it. Wisconsin has been proposing further cuts in reimbursment for years. In 2002, I reviewed the costs of our state's plan and found out something interesting. The cost of the plan had seen double digit increases for the previous 8 years. Pharmacy reimbursment rates remained the same over those same years. Hence, the reimbursment rate was not the cause of the escalating cost of Medicaid. The actual cost of medications are the bastard child that no one wants to acknowledge. Any change in rate is only a short-term easy bandaid that really won't solve the issue.
more than 90 percent of the savings would come from pharmacies.
As stated above, the reductions won't accomplish the desired effect. 90% of the effect will be on 5% of the problem. IMHO.
So what is the solution? Since the problem is associated with the escalation of prescription costs, ultra high pharmacy utilization, and the chronic multiple disease state patients, the only true solution is to run Medicaid like an insurance. Get your state to use strict formularies, get more pharmacy company rebates, and limit patient ability to get brand name drugs. Unfortunately, Wisconsin has only recently initiated the above requirements.
Lastly, the law of unintended consequences will turn up here. There is no reason why any pharmacy has to accept Medicaid. This will leave only a few chain pharmacies for the states to deal with. I would love to be Walgreens when they negotiate their contract, being the only pharmacy willing to deal with the state.
Soapbox over,
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