Florida Pharmacy Association sues to restore Medicaid patient access to community pharmacies

July 31, 2012

The Florida Pharmacy Association and others are suing to restore patient access to Medicaid pharmacy providers.

The Florida Pharmacy Association (FPA) and others are suing to restore patient access to Medicaid pharmacy providers.

In its lawsuit filed late last week in Leon County Circuit Court against the Agency for Healthcare Administration, the FPA said the Agency must stop enforcing contracts with for-profit health management organizations (HMOs) and other for-profit managed care organizations. The state agency’s recent change is forcing Medicaid patients to use only out-of-state pharmacies and affiliated mandatory mail-order pharmacies.

“We have recently learned that, over at least the last two-and-a-half years, the Agency has secretly been awarding contracts that amount to…a hand-off to HMOs in what we believe to be a full and illegal privatization of Medicaid for the majority of Medicaid patients,” said Lori Weems, general counsel and government consultant for FPA.

Earlier this month, the National Community Pharmacists Association (NCPA) requested a meeting with Florida Governor Rick Scott to discuss community pharmacists’ concerns. “Florida is attempting to build upon a questionable managed care platform that will grant out-of-state managed care plans and the PBMs an unprecedented ability to vary the amount, duration, and scope of pharmacy benefits to Medicaid beneficiaries,” wrote Matthew J. DiLoreto, director of state government affairs for NCPA, in the letter.

DiLoreto said that a number of Florida pharmacies recently received a letter demonstrating the “drastic impacts” that a managed care system would have on Floridians’ access to their community pharmacies. “The letter stated, with little warning and no reasonable explanation, that Medicaid patients will be forced to transition to a new CVS/Caremark limited closed network on July 9, 2012. Patients will then only be able to access medications at a CVS or Wal-Mart pharmacy, and thereby may be forced to sever the relationship they may have with their community pharmacist and receive care elsewhere,” DiLoreto wrote.