Medicaid Managed Care Organizations Testify to the Interim Health & Welfare Committee
On Wednesday, January 23 the Interim Health & Welfare Committee met and the Medicaid Managed Care Organizations (MCOs) were in the hot seat presenting information on their operations and programs they run. The newly selected chairs, Senator Ralph Alvarado (R-Winchester) and Rep. Kim Moser (R-Taylor Mill) requested the Medicaid MCOs present an update to the committee. All 5 MCOs, as well as the Kentucky Association of Health Plans (KAHP), testified for more than an hour, which frustrated some legislators who wanted to ask more questions than to hear information from the MCOs. All the plans were putting their best face forward, discussing positive provider experiences, programs and community involvement. Legislators were allowed at the end of the meeting to ask questions many of those around what the plans did not discuss, the issues they are hearing from Medicaid constituents, providers and others groups. Several legislators asked questions about rates and administrative cost.
Passport reported on issues with the cabinet relating to the 4.1 percent Medicaid capitation rate cut to the counties in the Louisville area. Senator Stephen Meredith (R-Leitchfield) asked several questions about the calculation of the Medical Loss Ratio and how the MCO determines what is considered medical versus administrative expenses. When legislators directly asked MCO representatives if they consider all the money they send to pharmacy benefit managers as medical, they said yes. This practice gives the MCOs, in collaboration with PBMs, the ability to manipulate the medical loss ratio. This could be a partial answer to the questions about low pharmacy reimbursements in Medicaid.
Chairman Ralph Alvarado (R-Winchester) clearly had lingering questions for the MCOs and stated that he would send follow-up questions to all the MCOs after the meeting. Sen. Alvarado also stated that he had met with Department of Medicaid staff on the issue of data collection and pharmacy reimbursement within Medicaid. According to his comments, the data will be released soon and provided to legislators and the public. Several legislators asked questions about the data collection and the information that may be provided, but the MCOs punted and said that they have turned over all the appropriate data to Medicaid. But legislators continue to ask to why the MCOs continue to cut dispensing fees and alter reimbursement rates without properly following the requirements of
Physicians Raise Concerns about Proposed Emergency Dispensing Legislation
Representative Danny Bentley (R-Russell) co-chaired the Diabetes Task Force that met over the summer. One of the recommendations from the task force is to allow a pharmacist to dispense an emergency supply of a prescription when the smallest unit of dose is larger than a 72-hour supply. This would only apply when patients have an existing prescription and have run out of refills. The state of Ohio has passed similar legislation after a tragic incident where a patient wasn’t able to get insulin when the refills expired and couldn’t get in touch with the practitioner. In this instance, a pharmacist couldn’t dispense insulin or other medications such as inhalers because insulin cannot be broken into a 72-hour supply.
The physicians have expressed concerns that Bentley’s proposed
is too broad and needs to limit emergency dispensing to medications such as insulin and inhalers. KPhA asked them for changes that they would like to see in the legislation and said that we will work with them and the sponsor on a resolution. The pharmacy community is not asking for this legislation, as it is being pushed by the diabetic patient advocacy community.