Medicaid recipients displaced by tornadoes can get emergency 30-day refills of prescriptions

Kentuckians on Medicaid who were displaced by last week's storms can get a 30-day supply of needed medicine from their pharmacy, the Department of Medicaid Services announced yesterday.

The right to receive an emergency refill applies to residents living in Ballard, Bath, Carroll, Campbell, Grant, Grayson, Hardin, Johnson, Kenton, Laurel, Lawrence, McCracken, Magoffin, Martin, Menifee, Montgomery, Morgan, Muhlenberg, Ohio, Owsley, Pendleton, Rowan, Russell and Trimble counties. Those counties have declared a state of emergency.

The state's four managed-care organizations are informing pharmacies of the policy, which was part of an executive order signed by Gov. Steve Beshear last weekend. Medicaid recipients who are not enrolled with an MCO can also receive replacement medications at their pharmacy. Co-payments will be waived.

"Many Kentuckians depend on regular maintenance medications, like blood pressure pills, and skipping a few days could cause unnecessary hardship or possible poor health outcomes for some citizens," Beshear said. "This order will allow people to contact a pharmacist to restore their regular medications." (Read more)

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Legislators hear from new managed-care firms; lawmaker rates their performance with a show of hands from pharmacists

Kentucky Health News

The three companies recently hired to manage Kentucky's Medicaid program outside the Louisville region defended themselves yesterday against complaints that they are squeezing independent pharmacies to the breaking point. One of the three firms, Kentucky Spirit, fared better in a hearing held by a House-Senate committee before a crowd that included many pharmacists.

When Sen. Vernie McGaha, R-Russell Springs, "asked for a show of hands from pharmacists in the audience to learn which of the three pharmacy-benefits companies they think underpay on generic drugs, nearly everyone raised their hands for Medco Health Solutions, which is Coventry [Cares]'s partner, and Catalyst Rx, which is WellCare [of Kentucky]'s. No one seemed to object to US Script, which is Kentucky Spirit's partner," reports John Cheves of the Lexington Herald-Leader.

Kentucky Spirit is the only firm that continues to pay pharmacists a dispensing fee of $4.50 to $5 per prescription, the rate that had been paid by the state. WellCare pays $3, and CoventryCares $1 to $1.50, the pharmacists told Deborah Yetter of The Courier-Journal. "Pharmacists have told lawmakers at previous hearings that pharmacy-benefits companies sometimes pay less for generic drugs than it costs pharmacies to acquire them," Cheves notes.

Read more here: http://www.kentucky.com/2012/02/13/2067444/medicaid-managed-care-companies.html#storylink=cpy

Rep. John Will Stacy, D-West Liberty, left, whose business interests include co-ownership of at least two pharmacies, got into it with G. William Strein, Medco's vice president for provider relations. "Stacy cut off Strein several times while he was attempting to answer," Cheves reports.

“Why is it fair that you can reimburse us below costs?” Stacy asked Strein, who "disputed Stacy’s assertion and said managed care attempts to strike a balance between its estimated cost of the drug and the costs of the pharmacy to buy and dispense it," Yetter reports. "But that claim was disputed by some of the roughly 30 pharmacists at the hearing who operate independent drugstores. Though the hearing ended before they got a chance to testify, several said afterward that they intended to keep making their case before lawmakers."

Jason Wallace, owner of Grant County Drugs, told Yetter, “It’s a real burden for Kentucky pharmacists. That’s why I’m here.” All the companies told members of the Joint Program Review and Investigations Subcommittee that they are committed to resolving the problems.

"Much of Monday’s testimony was devoted to the complex pricing formula known as the maximum allowable cost, or MAC, that managed care companies consider proprietary," Yetter writes. "Under the Medicaid plan before managed care, the formula was provided to pharmacists, who said they knew what they would be paid. Now, they said, they don’t find out what a company will pay for a specific drug until they file claims.And too often, they say, it’s less than they paid to buy the drug.

“How would you like to go to a gas station and fill your car up with gas and then be told what the charge is?” Breckinridge County pharmacist Jonathan Van Lahr asked after the hearing. (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Pure hydrocodone pain pill in testing; critics worry about abuse

A new pain pill, one more powerful than OxyContin and 10 times stronger than Vicodin, is being tested on patients by four drug companies and could be out as early as 2013. The new medicine, which is a pure form of hydrocodone, has law enforcement in Eastern Kentucky worried, reports Ralph B. Davis of the Floyd County Times.

"In my personal opinion, a drug like that shouldn't be a prescription medication," Floyd County Coroner Greg Nelson told the Times. "It should strictly be an in-house medication."

Drug maker Zogenix of San Diego plans to apply early next year to begin marketing Zohydro, a time-released drug intended to manage moderate to severe pain, reports Chris Hawley of The Associated Press. The drug has completed three rounds of testing.

Critics worry abusers will simply crush the pill to get an intense, immediate high. "I have a big concern that this could be the next OxyContin," said April Rovero, president of the National Coalition Against Prescription Drug Abuse.

The companies defend the drug by saying pure hydrocodone "would avoid liver problems linked to high doses of acetaminophen, an ingredient in products like Vicodin," Hawley reports. "They also say patients will be more closely supervised because, by law, they will have to return to their doctors each time they need more pills."

But critics remain unconvinced and are worried about the larger ramifications of the pills being on the market. "Hydrocodone abuse is already a tremendous problem in Southern and Eastern Kentucky," Karen Kelly, executive director of the government-funded anti-drug program UNITE, told Davis. "When used properly, these medications help many who are experiencing moderate to severe pain. Unfortunately, we have seen how easily the system can be abused."

Davis expressed his own views in an editorial that ran earlier this week. "The pharmaceutical companies developing Zohydro and other copycat drugs clearly must know that their products will kill people," he wrote. "They see it happening every single day. And they have been warned that the problem is growing worse."

Davis referred to a report by the Centers for Disease Control and Prevention, which found that in 2008, an average of 40 people a day in the United States died as a result of prescription painkiller overdoses, a 400 percent increase over 10 years. "Meanwhile, the pharmaceutical companies raked in billions in profits, and financial speculators are taking note," Davis writes. "Since stories about concerns over Zohydro first began appearing over the weekend, Zogenix's stock has skyrocketing nearly 70 percent ... To put it bluntly, this is horrifying." (Read more)

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