Senate priority bill would carve out pharmacy reimbursements from MCOs

01/10/2018 03:52 PM

One of the top priority Senate bills filed this year would move reimbursement for pharmacies under the Cabinet for Health and Family Services and away from Managed Care Organizations.

Sen. Max Wise, R-Campbellsville, said the measure is meant to “protect” retail and independent pharmacies in Kentucky.

Senate Bill 5, which was filed by Wise, would make the Department for Medicaid Services the administrator of all benefits payouts to pharmacies.

“It’s the reimbursement rates, of having to go through the MCOs, (managed care organizations) and this management group the – PBMs – the pharmacy benefit managers that are out there, and so we’re struggling right now in Kentucky on some of the reimbursement rates — that we may potentially see some independent pharmacy’s not be able to survive the next couple of years just based on the reimbursement rates they’re not getting back,” Wise told Pure Politics on Tuesday.

Moving the administration of the reimbursement will come with a cost. Wise said he was working closely with the Cabinet for Health and Family Services in addressing the cost of the change.

“This is going to be a big fight,” he said, adding there is momentum on his side.

Wise said the bill did not represent a move away from Managed Care Organizations, of which there are five in Kentucky, but rather a fight against out-of-state pharmacy benefit managers.

“There’s a convulsed transparency there that we’re not getting from the PBMs of how much money are you really making off this, and I wish it was something the Department of Justice and FBI would look into more on that level,” Wise said.


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