BATON ROUGE—Today, the Louisiana Department of Health and Hospitals released its pharmacy concept paper and announced a series of regional forums to discuss the modernization of Louisiana's Medicaid pharmacy program.
"We are continually examining our programs to determine how we can deliver more effective and efficient services for Louisiana residents," said DHH Secretary Bruce D. Greenstein. "With the first phase of BAYOU HEALTH implementation complete, we now look to bring those same principles of coordination and better care management to our pharmacy benefits program. Today's announcement marks the beginning of an open dialogue with recipients, providers, advocates and others to map out the best way to accomplish that."
BAYOU HEALTH is the State's new approach to coordinating care for most Medicaid and LaCHIP recipients. DHH has contracted with five Health Plans - Amerigroup RealSolutions, Community Health Solutions, LaCare, Louisiana Healthcare Connections and UnitedHealthcare Community Plan -- that are responsible for coordinating health care for recipients and working with them to address issues and empower them to take a more active role in owning their own health. BAYOU HEALTH was implemented for eligible Medicaid and LaCHIP recipients around Louisiana in three phases that each encompassed multiple parishes. The final implementation was June 1.
During this implementation phase, pharmacy was one of several services that were "carved out" of BAYOU HEALTH, meaning Medicaid recipients in a BAYOU HEALTH Plan got prescriptions filled and received other pharmacy services through the legacy Medicaid fee-for-service program. Now, DHH is moving forward with adding pharmacy as a benefit for recipients in the three BAYOU HEALTH plans that are a prepaid model, meaning they operate as traditional, MCO-style health care networks with a capitated rate. The three BAYOU HEALTH prepaid plans are Amerigroup, LaCare and Louisiana Healthcare Connections.
"We're eager to see how the State's concept paper on bringing pharmacy coverage into Bayou Health will further improve health care for Louisiana's 870,000 Medicaid recipients in BAYOU HEALTH Plans," said Jeff Drozda, CEO of the Louisiana Association of Health Plans. "We've already seen successes from the Health Plans working with Bayou Health, and credit those successes to the spirit of collaboration and transparency among DHH and its partners."
The other two plans, Community Health Solutions and United Healthcare Community Plan, are enhanced primary care case management networks. These Plans process and pay claims using the Medicaid fiscal intermediary, and pharmacy benefits for recipients in these networks would continue through the legacy Medicaid fee-for-service program. Membership in these two Plans, combined with those individuals remaining in legacy Medicaid, account for more than half of Medicaid recipients. Concurrent with adding responsibility for pharmacy services to the prepaid plans, DHH is laying the groundwork and seeking feedback on how best to strengthen the legacy Medicaid pharmacy program, which will continue to manage pharmacy benefits for these individuals.
Secretary Greenstein and DHH Medicaid leadership have written a concept paper outlining their plan to include pharmacy as a benefit of the BAYOU HEALTH prepaid plans, and addressing aspects of the current Medicaid Pharmacy Benefits Program they wish to transform for recipients in the shared savings plans and those recipients remaining in legacy Medicaid. This paper, which is available online at www.MakingMedicaidBetter.com, has been posted for public comment and feedback. DHH will use this feedback to guide the formation of final rules, contract amendments and internal policies.
Additionally, DHH will seek public input through six regional forums in June, four of which will take place after business hours so pharmacists and others can attend after work. These forums are public meetings, and no registration is required.
Monday, June 18 - Lafayette
Clifton Chenier Center - Auditorium
200 West Willow St.
Lafayette, LA 70501
Tuesday, June 19 - Monroe
University of Louisiana at Monroe
College of Pharmacy - Room 170
1800 Bienville Drive
Monroe, LA 71201
Tuesday, June 19 -Shreveport
6:30 - 8:30 p.m.
LSU Health Sciences Center - Shreveport
Medical School Auditorium
Building C - Room 1-400
1501 Kings Highway
Shreveport, LA 71130
(Reserved parking will be available)
Wednesday, June 20 -Alexandria
915 3rd St.
Alexandria, LA 71309
Tuesday, June 26 - Greater New Orleans
West Bank City Council
General Government Building
200 Derbigny St., 6th floor
Gretna, LA 70053
Wednesday, June 27 -Southwest Louisiana
10:30 a.m. - 12:30 p.m.
Lake Charles Civic Center
Jean Lafitte Room
900 Lake Shore Dr.
Lake Charles, LA 70601
Wednesday, June 27 -Baton Rouge
Galvez Building - Oliver Pollock Room
602 N. Fifth Street
Baton Rouge, LA 70806
"Necessary prescription drugs are essential to sustaining and saving lives, and access to these drugs and appropriate medication therapies saves billions of dollars in health care expenditures," said Randal Johnson, president & CEO of the Louisiana Independent Pharmacies Association. "Louisiana pharmacies work every day to provide the best pharmacy care and appreciate the opportunity to discuss how to best deliver this care to the Medicaid patients in Louisiana with the support of Department of Health and Hospitals and other stakeholders. Our pharmacists are dedicated to serving their communities, and these are important decisions that can have a tremendous impact on all Louisiana citizens' access to prescription drugs."
"On behalf of our chain pharmacies operating more than half of the retail pharmacies throughout Louisiana, we appreciate the opportunity to have this important dialogue with the Department on how we can work together to strengthen Louisiana's Medicaid pharmacy program," said Mary Staples, Director of State Government Affairs with the National Association of Chain Drug Stores. "Pharmacists provide a critical service and will play a key role in efforts to improve health outcomes through Louisiana's Medicaid reform program. We look forward to reviewing the concept paper and offering our input to ensure best practices are utilized to protect our patients and provide maximum value for the State."
At these forums, DHH Medicaid program leadership will give an overview of the planned transition of pharmacy into BAYOU HEALTH along with potential strategies to improve Medicaid Pharmacy Benefits Management and engage in an open dialogue with advocates and stakeholders to answer common questions and clear up any misunderstandings about what such an inclusion would mean.
The forum schedule is available online at www.MakingMedicaidBetter.com. Please check back often to see any updates to the schedule.
DHH has also added a "Pharmacy" section to www.MakingMedicaidBetter.com, which will be updated frequently during this process. The public is advised to check here often to see the latest details. Visitors to the site also can review information about BAYOU HEALTH, subscribe to DHH's newsletter for frequent email updates and submit questions or comments electronically.