Small pharmacies oppose efforts to tighten managed-care networks

The Senate Health Policy Committee on Tuesday heard a workshop about changes to the state’s managed-care plans as they relate to pharmacists.

The state Agency for Health Care Administration’s Deputy Secretary for Medicaid Justin Senior said the current plan works just fine, with providers abiding by strict time and distance standards: the maximum time from a pharmacy in an urban county in 30 minutes, for instance, or 60 for rural counties.

Some large pharmacy benefit managers have sought to restrict access to smaller pharmacies working with the state system, and smaller pharmacists are feeling the squeeze, with less foot traffic and fewer customers.

Committee Chairman Aaron Bean put the question succinctly to Senior: “What do you say to the mom and pop” pharmacies?

Senior responded by saying if customers are transferred to one plan to another and find their previous providers out-of-network, they can switch, and ascribed recent successes in the system to ongoing changes the small pharmacists oppose. Audrey Brown with the Florida Association of Health Plans agreed, saying the statewide managed care program provides expanded benefits and a high degree of access.

Several local businesses disagreed, offering myriad reasons.

Ron Pickens with EPIC PharmPAC, a Jackson County-based consortium of pharmacists said it’s “not as easy as it may sound” to switch once a benefit provider has transferred a patient to a new plan. Pickens also cited language barriers certain small providers can alleviate, as well as a need for HIV/AIDS patients and other conditions for boutique-style care sensitive to their particular ailments.

Two representatives of Smart Pharmacy say patients depend on their auxiliary services such as delivering prescriptions for free, unlike chain pharmacies.

“This managed care thing; it just doesn’t work,” said the pharmacy’s Bill Scroggins. “People fall through the cracks.”

Multiple testifiers also cited customer problems switching their plans, saying it was near-universally a bureaucratic hassle.

Senior said delivery and other auxiliary services are taken care of by existing benefit managers via free available transportation to the pharmacies, though he granted that fact was “not widely known.”

“We can have savings, we can have quality – we can have it all,” Bean said in closing.

No vote was taken on a specific proposal.