State lawmakers expect to save more than $100 million by including pharmaceutical reimbursements in Medicaid managed care, which was rolled out across the state this year. But pharmacists and small-business owners are crying foul, saying the lowered rates could run independent pharmacists out of business and greatly reduce Medicaid patients' access to medication.
The interactive map below shows Medicaid patients’ access to pharmacies across the state by comparing the location of pharmacies serving Medicaid patients as of March 2012 to the percentage of the county population enrolled in Medicaid as of August 2011 — the most current available enrollment data. The Tribune calculated the percentage of the county population enrolled in Medicaid by combining enrollment data with 2011 county population estimates* from the Texas Department of State Health Services.
|2011 County Population*||
Total Medicaid Enrollment,
Children Under 19 Enrolled in Medicaid,
Percentage of 2011 County
Under managed care, the state pays a set fee to approved insurance organizations to handle Medicaid patients' health care, which helps contain costs. Advocates for independent pharmacies, such as American Pharmacies and the Texas Pharmacy Business Council, say managed-care organizations have reduced reimbursement rates below the actual cost it takes small businesses to fill prescriptions, which has already caused a handful of pharmacies to fire employees, sell their business or close down.
At least one pharmacy that says it closed because of the change to managed care, Mom’s Pharmacy in Weslaco, is still included in the data provided by HHSC. It’s possible other pharmacies that closed or were sold are also included in the map because they had not informed HHSC by March 20. The map also includes scattered pharmacies across the country that accept Texas Medicaid patients.
Opponents say the lowered reimbursement rates will be particularly detrimental to independent pharmacies in areas with a high percentage of the population enrolled in Medicaid, such as South Texas and impoverished urban neighborhoods.
The map reveals that there are rural areas of the state with a limited network of Medicaid pharmacy providers. Twenty-nine rural counties have zero pharmacies that accept Medicaid patients, including Presidio along the Texas-Mexico border, where nearly 2,000 people — or 22 percent of the population — are enrolled in Medicaid. Zoom in to urban areas for a clearer view of the distribution of pharmacies that serve Medicaid patients.
HHSC is keeping a close watch on the transition to ensure patients don't lose access to their medication, said Stephanie Goodman, a spokeswoman for the Health and Human Services Commission, adding that pharmacies should give the new model a chance to work. "This isn’t some radical new concept," she said in an email, adding that "it’s the same way most people with private insurance get their prescriptions."
For more information about the effects of managed care on pharmacies, see a related Tribune article here.