Medicaid Mail Order and Network Closure Defense Fund
Members Asked to Make Contributions
What is this defense fund for?
mid November of 2010 the Agency for Health Care Administration (AHCA)
published an invitation to negotiate (ITN) for vendor pharmacies to bid
for a mail order program for 20,000 chronically ill Florida Medicaid
recipients. It was AHCA’s intent to issue only one contract for these
services which would likely mean that these patients could be served by
only one mail order pharmacy provider. Since then the
bids for the ITN have been rejected and a new ITN has been issued.
There does not seem to be any further activity in this area.
What has been done about this?
FPA had filed a formal protest against the Agency for Health Care
Administration's efforts to facilitate this mail order program. This
initial filing by the FPA had resulted in postponement of any
solicitation activities by the state. During the 2010 Legislative
session the FPA successfully fought back repeated attempts to put into
place a mail order program for Medicaid patients (see June 2010 issue
of Florida Pharmacy Today). This mail order program however, was
inserted into the state’s budget during negotiations between the House
and Senate. This proposal in effect required the Agency to identify
20,000 chronically ill Medicaid patients that could be eligible for
mail order. This was done in such a way that made it impossible for
public input or debate. During the 2011 session the language was
reinserted that made it optional for the program to go forward.
Why was it necessary to challenge this issue?
FPA was concerned that such a program would have undermine quality and
continuity of care. Some of the issues include but are not limited to
Patients, particularly the developmentally disabled may not understand
their need to stay with their current pharmacist of record and would
feel compelled to accept the mail order offer. Official letters from
the Agency for Health Care Administration are overwhelmingly suggestive
to Florida’s indigent. These patients may feel forced to go to mail
order or risk losing their prescription drug benefits.
The coordination of care is essential to facilitating positive quality
outcomes. Patients under this plan may find themselves having to use
more than one pharmacy. They will likely get their maintenance
medications from the contracted mail order facility and their acute care
medications from other providers. This is not a good model for patient
care in today's health care environment.
Small family owned pharmacies cannot possibly compete with well
financed and heavily resourced mail order facilities submitting bid
proposals to AHCA and navigating their extremely complex invitation to
negotiate process. In some cases if a large mail order provider who also
happens to be the claims processor for independent pharmacy providers
wins the bid then they will likely use their data mining capabilities
to divert non-chronically ill patients away from these small
Many community pharmacy providers are already using mail and other
delivery services to patients that are home bound or in remote
locations. This proposal may take that service away from Florida
businesses for some patients.
How would have this issue affected me?
you are a Florida Medicaid pharmacy provider it is very likely that
some of these patients are currently being taken care of by you. You
may discover that these patients could be encouraged to use a mail order
pharmacy for their maintenance drugs. While on the surface it appears
that the number of patients is small the FPA believes that this
represents a significant amount of the spending in the Medicaid
population. You will also be challenged with managing their
prescription drug therapy without the benefit of their full history.
What will my contribution be used for?
the wavering of the ITN issue your continued support is being used to
fight other relevant issues with the Agency such as the closure of the
pharmacy networks. All of your support of this effort will go into a
restricted account towards the direct costs related to a challenge
before the Agency. This includes lawyer and consultant fees and
expenses, filing fees and other direct litigation costs.
What are my contribution limits?
and corporate funds will be accepted and there are no limits to the
amount that you can give. Your corporate contributions may be tax
deductible as a business expense. Consult your accountant for more