State Medicaid system ‘rigged’

http://www.miamiherald.com/opinion/letters-to-the-editor/article107271937.html

While we ponder our choices (or lack of) awaiting open enrollment, an assault on the American Dream is being waged against small pharmacies in Florida.

“Work hard, play by the rules and prosper” is a nightmare for our independent, or indie, pharmacists. The playing field has never been level, but now these stand-alones are largely out of network in privatized Medicaid plans. They’re required to pay Medicaid taxes but can’t fill Medicaid prescriptions. This is troubling.

Indies offer a plethora of goods and services large chains can’t, don’t or just won’t. Indies meet your eyes when you arrive. They know your health profile like the back of their hand. They fill hundreds of prescriptions a day, as opposed to thousands. For the housebound, they’ll home deliver. There’s on-site compounding, diabetic supplies, free health magazines, etc. Whatever you need they’ll order. That’s the point, to treat the whole patient, not just fill a prescription.

Gov. Rick Scott’s privatization of Medicaid was supposed to be about free enterprise. That’s just a guise.

Here’s an example of why I need my indie: When he caught wind of a price hike on one of my prescriptions, he stocked up, and gave me a 90-day heads up. Can you imagine that happening with an hourly worker at a supermarket chain?

Behemoths have their benefits, like being open 24/7. That’s not helpful if you’re really sick, live hours away or don’t drive. They have databases, but a computer won’t pick up on the pallor or sudden weight loss of a patient. For that, you need a human being.

Corporate outfits claim lower prices negotiated by their powerful Pharmacy Benefit Managers (PBM), who claim to be part of the solution. But the top three PBM’s have three-quarters of the market share. They profit from every transaction and also can own drugstore chains. This gives them incentive to drive patients toward their stores by any means possible. It’s the American way, right?

Not in this case. We need to outlaw closed pharmacy networks and insist on fair play for the corner mom-and-pop shop. Small businesses drive our economy.

Filed under: General Problems