|Fort Thomas Drug Center. FTM file.|
The Kentucky House of Representatives passed a measure aimed at providing additional oversight and ensuring cost savings in administering pharmacy benefits for Medicaid recipients in Kentucky.
HB 222, sponsored by Representative Steve Sheldon, R-Bowling Green, would require the Department for Medicaid Services (DMS) to contract with a single independent entity to monitor all Medicaid pharmacy benefit claims.
“In 2020, our state transitioned to a single pharmacy benefit manager, or PBM,” Sheldon said.
“HB 222 continues to build on that legislative success by allowing the Department for Medicaid Services to contract with a company that will find administrative mistakes when handling pharmacy benefit claims. These mistakes can unfortunately be very costly, and this bill will continue to promote increased cost savings to the taxpayers and to the state as a whole.”
The bill is a net positive in the eyes of local independent pharmacist, Craig Seither of Fort Thomas Drug Center.
“The fleecing of Kentucky taxpayers as it pertains to managing the prescription benefit for Medicaid Patients is coming to a close," he told Fort Thomas Matters.
"Patients, taxpayers, and providers have suffered for the last 10 years with the implementation of managed Medicaid in KY. These “middleman” have billed the taxpayers high, and payed the provider low, many times less than the cost of the medication. Naturally, this “price gouging model” created hardships with Pharmacy closures and reducing healthcare accessibility. The future is more transparent with one Pharmacy Benefit Manager (currently several) operating in a fair manner. The result will be greater savings for the taxpayers, better care for the most fragile in our society, and a pharmacy that can keep the lights on.”
HB 222 would require the contract to last for no longer than two years, and to be eligible for the contract the selected entity must have at least five years of experience reviewing and auditing pharmacy claims. The entity would be tasked with identifying and correcting errors in pharmacy benefit claims, as well as identifying underpayments made by the state pharmacy benefit manager to pharmacies. Total compensation paid by DMS to the contracted entity during the initial two year contract period is capped at 30 percent of the total savings generated by the contracted entity. This means Kentucky would retain 70 percent in savings from discovered errors.
“This is the proverbial win/win,” Sheldon added. “The company is paid based on how much they save the state.”