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Legal Defense Fund

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

You can increase your contribution by changing the quantity at checkout.  Your support is critical to the success of this defense effort.

What is this defense fund for?

Medicaid was designed to be the health insurer of last resort for the youngest, sickest, frailest and most vulnerable Floridians in need of the most comprehensive and personalized direct patient care possible. In the last several sessions and special sessions, the Florida Legislature has worked tirelessly to enact multiple laws to assure Florida’s Medicaid program was not handed over to HMOs without strict oversight, regulation and accountability.  We have recently learned that over at least the last two-and-a-half years the Agency has secretly been entering and awarding contracts that amount to just such a hand-off to HMOs in what we believe to be a full and improper privatization of Medicaid for the majority of Medicaid patients.

What has been done about this?

The FPA met with the Agency for Health Care Administration on this issue, filed related comments with the Center for Medicare and Medicaid Services (CMS) and testified at a number of regional meetings facilitated by the Agency expressing concerns over mandatory mail order and closed pharmacy networks.

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 or other pharmacy provider. Official letters from the Agency for Health Care Administration are overwhelmingly suggestive to Florida’s indigent. These patients may feel forced to go to a restricted pharmacy provider 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 competitor pharmacy for some or all of their maintenance drugs. While on the surface it appears that the number of patients is small the FPA believes that this could  represent 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 if you are allowed to be their provider.

What will my contribution be used for?

With the wavering of the ITN issue your continued support is being used to fight network closure issues with the Agency. 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.