IEHP issued the following announcement on Nov. 22.
In an effort to advocate for the communities and members they serve, Inland Empire Health Plan (IEHP) CEO, Jarrod McNaughton, contributed to the California Pharmacy Carve Out discussion in the MJH Life Sciences publication, Managed Healthcare Executive to explain how it impacts IEHP members, providers and local community.
The California Pharmacy Carve Out will move 13 million Medi-Cal beneficiaries to a private for-profit pharmacy benefit manager (PBM) by 2021. While some pros include centralized drug rebates and uniform benefit, McNaughton expressed that a larger concern is care coordination, which may become more difficult.
"This new direction in Medi-Cal is taking out of the plan responsibility one of the key elements of care, the pharmacy benefit, and moving its function and operation to the state under a centralized, for-profit pharmacy benefit manager," McNaughton shared. "What is currently a crucial cornerstone in coordinating care by making sure our members and providers have access to local plan team members to call and ask questions regarding the pharmacy benefit, will be moved to a centralized function in Sacramento."
The Pharmacy Carve Out as proposed, is likely to impact the relationships between providers and local pharmacies, resulting in the reduction of personalized and localized care that is unique to the Inland Empire.
McNaughton believes there are other alternatives to the Governor's goal of reducing rising drug costs that continue the current local connection to providers and patients.
"We have shared our specific ideas with the state and hope they will be open to the idea of collaborating to find ways we can meet the local needs of our members while achieving the Governor's goal," McNaughton added.
IEHP, Inland Empire Health Plan, is a not-for-profit Medicaid and Medicare health plan located in Rancho Cucamonga, California. With a network of more than 6,400 providers and more than 2,000 employees, IEHP serves more than 1.2 million residents in Riverside and San Bernardino counties who are enrolled in Medicaid or Cal MediConnect Plan (Medicare-Medicaid Plan). Through a dynamic partnership with Providers, award-winning service and innovative products, IEHP is fully committed to providing our Members with quality, accessible and wellness-based health care services. For more information, visit www.iehp.org.
Original source can be found here.