Bill to increase pharmacy rate transparency advances

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Monday, May 20, 2013 - 12:08pm

Independent pharmacists struggling to keep their doors open could soon expect more transparency in negotiating rates with Medicaid managed care organizations.  

Reimbursement rates were the same throughout the state until March 2012 when Texas expanded managed care. Once that happened, pharmacists were required to sign contracts with multiple managed care organizations and agree to rates set forth for Medicaid prescriptions.

They often wouldn't know the rates they'd be paid for specific drugs prior to signing the contract.

On Friday the Texas House gave tentative approval to Senate Bill 1106, by state Sen. Charles Schwertner, R-Georgetown, which would require Medicaid managed care plans to disclose how they determine the maximum amount they'll reimburse a pharmacist for a drug.

State Rep. Doug Miller, R-New Braunfels, took the transparency bill a step further, offering an amendment that would require Medicaid managed care plans to report to the state quarterly how much they're paying each provider in their network for the same drugs. It would show if they're paying different amounts to different providers.

Miller asked that the body "vote for the amendment if you're going to vote for your local pharmacist." State Rep. John Davis, R-Houston, the bill's House sponsor, initially fought the amendment. Once the motion to table it failed, Davis accepted the amendment and the bill passed to third reading.

The goal of the legislation is to ensure that low reimbursement rates don't drive pharmacies that dispense generic drugs to Medicaid patients out of business.

Becca Aaronson contributed to this report.

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This article originally appeared in The Texas Tribune at http://www.texastribune.org/2013/05/17/house-advances-bill-protect-pharmacies-low-medicai/.

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