A state lawmaker said Monday that she has been "inundated" with complaints from pharmacists about low reimbursement rates being paid by the managed-care companies that in March took responsibility for certain high-needs Medicaid recipients.
"I've got multiple pharmacies that are saying they're getting killed on these plans," Rep. Denise Garner, D-Fayetteville, said.
Garner quizzed the managed-care company executives about the pharmacists' complaints during a joint meeting Monday of the House and Senate State Agencies and Governmental Affairs committees.
The hearing was the committees' third in just over a month on health care providers' complaints about problems with the managed-care initiative, including providers' difficulties billing the companies.
The managed-care companies on March 1 began providing health benefits to about 45,000 Medicaid recipients with significant mental illness or developmental disabilities.
Representatives of the three companies said Monday that, on average, firms known as pharmacy benefit managers that pay their drug claims are paying pharmacies more for generic drugs than the traditional Medicaid program did.
But they said the amount varies depending on the particular drug. Some pharmacies may be receiving less than they did from the Medicaid program, they said.
John Vinson, chief operating officer of the Arkansas Pharmacists Association, said the companies' figures on reimbursement don't account for "clawbacks" that pharmacy benefit mangers use to recoup money from pharmacies.
Act 994, signed by Gov. Asa Hutchinson last month, prohibits such recoupments, but it doesn't take effect until late July.
Pharmacists were already upset about the clawback provisions being included in contracts with commercial insurance plans, Vinson said. When they saw the same provisions included in the Medicaid managed-care plans, he said, "It was like a double slap to the face."
Known as Provider-led Arkansas Shared Savings Entities, or PASSEs, the companies receive monthly payments from the Medicaid program in exchange for paying for the medical care, prescription drugs and other services for recipients assigned to the company's plan.
The initiative is designed to save the state money while generating premium tax revenue that can be used to reduce the number of children and adults with developmental disabilities who are on a waiting list for home- and community-based services.
As of February, about 4,600 Arkansans were receiving the services and more than 3,100 others were on the waiting list.
After the meeting on Monday, Vinson credited Department of Human Services officials for prodding the companies to speed up their payments to pharmacists.
The companies' contracts with the department require them to pay 70% of "clean" claims submitted by providers within seven days.
In an April 29 memo, a Human Services Department attorney clarified that deadline also applies to payments from pharmacy benefit managers to pharmacies.
Previously, Vinson said, the managed-care companies had been paying the pharmacy benefit managers within seven days, but the pharmacy benefit manager then waited up to 30 days to pay the pharmacy.
He said the department had also helped ensure that the managed-care companies comply with a requirement to cover the same drugs as the Medicaid program.
"Our experience has been, when a pharmacist or doctor can actually get to the right person, those issues get resolved," Vinson said.
The company executives said during the meeting they have been working to address issues that have prevented some providers from being able to successfully submit claims.
John Ryan, chief executive of Arkansas Total Care, said his company paid five times more claims in April than it did in March.
He added that so far, the company has paid 79% of claims within seven days. During the first 10 days of this month, it met the goal 87% of the time, he said.
"I do believe that we've made significant progress," he said.
Metro on 05/14/2019