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Legal Defense Fund

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Medicaid Mail Order and Network Closure Defense Fund
Members Asked to Make Contributions

What is this defense fund for?

During 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?

The 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?

The 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 the following:

1) 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.

2) 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.

4) 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 businesses.

5) 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?

If 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?

With 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?

Personal 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 information.