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
What has been done about this?
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?
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 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.
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 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?
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?
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