Arlington, Va. – The National Association of Chain Drug Stores (NACDS) commented this week on proposed regulations that would guide the use of managed care in Medicaid and in the Children’s Health Insurance Program (CHIP).
NACDS urges creating “standards that will serve to maintain the strong link between Medicaid patients and community pharmacies and the valuable services that these pharmacies provide.”
NACDS submitted comments to the Centers for Medicare & Medicaid Services (CMS) to help “create standards that will serve to maintain the strong link between Medicaid patients and community pharmacies and the valuable services that these pharmacies provide.”
Managed care refers to a system of healthcare delivery intended to help control costs, the use of services and quality. The Avalere Health consultancy projects that more than three-in-four Medicaid and CHIP beneficiaries will be in managed care programs in 2016 – up from 67 percent in 2013.
NACDS focused its comments on six key areas:
- Covered Outpatient Drugs – for example, preventing mandatory use of mail-order pharmacies, and preventing a reliance on closed networks for cutting-edge specialty medications;
- Network Adequacy and Availability of Services – advancing the belief that “patients should be allowed the freedom to select a pharmacy that best fits their personal health needs and provides the most accessible care,” particularly with mobility challenges faced by many Medicaid beneficiaries;
- Program Integrity and Auditing – recognizing the “balance between the need to ensure integrity in the Medicaid program and the need to afford due process and equal protection to providers”;
- Medical Loss Ratio – allowing medication therapy management (MTM) services to be considered as a healthcare activity, rather than an administrative cost, when calculating the ratio used to determine whether plans are spending adequately on patient care;
- Provider Payment Initiatives – incorporating innovative pharmacy services as part of managed care organizations’ strategies for delivering healthcare services;
- Development of a Medicaid Managed Care Quality Rating System – including appropriate medication-use metrics in healthcare quality ratings, and fostering consistency of these metrics across healthcare programs and across states
NACDS indicated its support for “efforts to develop a framework and rules to govern managed care plans that will ensure patient access to all healthcare services” and said it will “look forward to working with CMS on these very important issues.