Reimbursement rates in new system concern pharmacists

Pharmacists concerned over new care system

LITTLE ROCK, AR (KAIT/KARK) - A new system in place changes how Medicaid is billed for about 50,000 Arkansans that have developmental disabilities or severe mental illness.

As Little Rock television station KARK reports, the Arkansas Department of Human Services moved to the managed care system on March 1.

Three companies that are known as PASSEs are responsible for paying for members’ Medicaid services.

COO of the Arkansas Pharmacists Association John Vinson is worried what will take longer to resolve an issue with the entities that the PASSEs have hired to process the claims.

“The pharmacy benefit managers are paying below costs for the pharmacies to buy the drug and to operate,” Vinson told KARK. “That’s a much bigger challenge, and I’m not sure when the resolution will occur on that.”

Right now, the Arkansas Insurance Department regulates the PBMs, which are the middlemen between pharmacists and insurance providers.

The new law came to light after pharmacists blamed PBMs for major cuts to their reimbursement rates.

As for the new system, if patients haven’t received their ID cards, the DHS said they can still receive services from their provider with their Medicaid ID.

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