DHH Releases Final Pharmacy Reform Concept, Announces Stakeholder Meeting

Today, the Louisiana Department of Health and Hospitals released its final pharmacy reform concept and announced a public stakeholder meeting next Wednesday, Aug. 29, to present the department's plans and answer questions about the modernization of Louisiana's Medicaid pharmacy program.

Bayou Health is the State's new approach to coordinating care for most Medicaid and LaCHIP recipients. DHH has contracted with five Health Plans - Amerigroup RealSolutions, Community Health Solutions, LaCare, Louisiana Healthcare Connections and UnitedHealthcare Community Plan -- that are responsible for coordinating health care for recipients and working with them to address issues and empower them to take a more active role in owning their own health. BAYOU HEALTH was implemented for eligible Medicaid and LaCHIP recipients around Louisiana in three phases that each encompassed multiple parishes. The final implementation was June 1.

During this implementation phase, pharmacy was one of several services that were "carved out" of BAYOU HEALTH, meaning Medicaid recipients in a BAYOU HEALTH Plan got prescriptions filled and received other pharmacy services through the legacy Medicaid fee-for-service program. Now, DHH is moving forward with adding pharmacy as a benefit for recipients in the three BAYOU HEALTH plans that are a prepaid model, meaning they operate as traditional, MCO-style health care networks with a capitated rate. The three BAYOU HEALTH prepaid plans are Amerigroup, LaCare and Louisiana Healthcare Connections. These plans will begin managing pharmacy services on October 1.

The other two plans, Community Health Solutions and United Healthcare Community Plan, are enhanced primary care case management networks. These Plans process and pay claims using the Medicaid fiscal intermediary, and pharmacy benefits for recipients in these networks will continue through the legacy Medicaid fee-for-service program. Membership in these two Plans, combined with those individuals remaining in legacy Medicaid, account for nearly 62 percent of Medicaid recipients.

Concurrent with adding responsibility for pharmacy services to the prepaid plans, DHH will continue to work with stakeholders as it moves forward with plans to strengthen the legacy Medicaid pharmacy program, which will continue to manage pharmacy benefits for these individuals.

In June, Secretary Greenstein and DHH Medicaid leadership released an initial concept paper outlining their plan to include pharmacy as a benefit of the BAYOU HEALTH prepaid plans, and addressing aspects of the current Medicaid Pharmacy Benefits Program they wish to transform for recipients in the shared savings plans and those recipients remaining in legacy Medicaid. This paper was posted for public comment and feedback. Additionally, DHH sought public input through seven regional forums in June, four of which took place after business hours so pharmacists and others could attend after work.

DHH has taken that feedback and made several significant changes to the pharmacy reform plans. Today, DHH is releasing a final reform concept that outlines these changes and the details of what will be included in the rules and contracts that govern the Bayou Health pharmacy program.

DHH will hold a public stakeholder meeting next week:

Wednesday, August 29
2:30 - 4 p.m.
Department of Health and Hospitals - Bienville Building
Room 118
628 N. 4th Street
Baton Rouge, LA 70802

At this meeting, DHH Medicaid program leadership will give an overview of the planned transition of pharmacy into Bayou Health and answer questions about the final reform components.

DHH has added a "Pharmacy" section to www.MakingMedicaidBetter.com, which will continue to be updated frequently during this process. The public is advised to check here often to see the latest details. Visitors to the site also can review information about Bayou Health, subscribe to DHH's newsletter for frequent email updates and submit questions or comments electronically.