Health Department Issues Final Pharmacy Reform Concept, Sets Bayou Health Carve-In for Nov. 1

The Louisiana Department of Health and Hospitals (DHH) released its final reform concept for incorporating pharmacy as a benefit in three of the five Bayou Health Plans and simultaneously enhancing the State-run Medicaid Pharmacy Benefits Program, which will continue managing pharmacy services for more than half of Medicaid recipients.

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 theirhealth.

As Bayou Health was implemented earlier this year, pharmacy was one of several services that were "carved out," 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 will add 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 November 1.

DHH initially intended for the pharmacy carve-in to begin in October, but because of delays from Hurricane Isaac, DHH has shifted the carve-in to begin Nov. 1, allowing more time for stakeholders to give feedback, and to allow providers more time to explore their options for contracting with Bayou Health Plans.

The other two plans, Community Health Solutions and United Healthcare Community Plan, are enhanced primary care case management networks that process and pay claims using the Medicaid fiscal intermediary. After the Bayou Health carve-in for the pharmacy benefits, recipients in these networks and those not in Bayou Health, which account for nearly 62 percent of Medicaid recipients, will continue to receive pharmacy services through the legacy Medicaid fee-for-service program.

Concurrent with the Bayou Health carve-in, DHH will continue to work with stakeholders as it moves forward with plans to strengthen the legacy Medicaid pharmacy program.

DHH held a public stakeholder meeting on its pharmacy reform concept Wednesday, Sept. 12, and provided a fact sheet, provider notice and members notice on the coming changes. These items, and the presentation given at the public stakeholder meeting, are available at www.MakingMedicaidBetter.com, under the "Pharmacy" section.

Provider Calls on Pharmacy Carve-In

DHH has scheduled a series of provider calls to address concerns and answer questions about the Bayou Health pharmacy carve-in.

Beginning Nov. 1, Louisiana Medicaid and LaCHIP recipients enrolled in the Amerigroup, LaCare or Louisiana Healthcare Connections Bayou Health Plans will begin to have their prescription drugs and pharmacy services managed through their plans.

To prepare providers for this transition, Bayou Health is modifying its daily provider call schedule to focus on pharmacy questions and comments. Beginning Monday, September 17, the following call schedule will be in place:

• Monday - Primary Focus on Pharmacy Questions and Comments
• Tuesday - Primary Focus on Pharmacy Questions and Comments
• Wednesday - Hospitals, physicians and other provider types
• Friday - Primary Focus on Pharmacy Questions and Comments

All calls will take place from noon to 1 p.m. The call-in information (pre-registration is not required) is:

    Call-in #: 1-888-278-0296

    Access Code: 6556479#

Thursday calls will continue to focus on specialized behavioral health services, and will be conducted through Magellan/Louisiana Behavioral Health Partnership. The call-in information for this call is:

    Call-in#: 1-888-205-5513

    Access Code: 827176

Any provider is welcome to call on any of the days, but Bayou Health staff will give priority to questions from the designated provider type for that call, and will have staff who work in that provider area on the line to assist.

Contact Us

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.

Stakeholders are also welcome to submit comments and questions via email to bayouhealth@la.gov. Typically, staff are able to provide the requested information within one business day.