Pending Medicaid policy change could impact Mom and Pop pharmacies

Many family pharmacists are outraged and worried over a pending change in Medicaid policy.

Molina Healthcare, one of the two Medicaid HMO providers in the area, will no longer cover prescriptions from several independent northwest Florida pharmacies in their new network which kicks in October 1.

The bigger pharmacies like Walmart and CVS will remain on its network. The other insurance HMO provider Humana stopped covering mom and pop pharmacies several months ago.

Kim Cadenhead of Kim’s Family Pharmacy in Cantonment says it will affect many of their patients.

“We earn every one of our patients’ business,” she said, “They choose us because are part of the community. They choose us.”

When Humana dropped them from its network, Cadenhead says it was a dagger to the pharmacy. They lost about 30 percent of their business. She also heard similar losses from other pharmacists in the area.

“This will be a bigger blow,” she said of the pending Molina policy change. “It’s going to be a similar loss but each loss hits you harder and harder.”

Molina released the following statement to WEAR:

“As part of our commitment to high quality care, Molina Healthcare is always striving to ensure that our members have access to primary care physicians, specialists and pharmacies to meet their health care needs. We recently made some adjustments to our pharmacy network that will become effective November 1, 2016. We will continue to have a robust pharmacy network to serve our members, which includes several independent pharmacies. The decision to change our pharmacy network was a result of the completion of a detailed analysis, which considered time, distance, patient volume and costs. These network changes are in compliance with our Statewide Medicaid Managed Care contract with the state. To ensure a smooth transition and continuity of care, Molina members will have access to the current pharmacy network until December 31, 2016.”

State Senator Greg Evers felt that the move is an attack on small businesses.

“These are the folks that help support the little league, the football teams he said,” Evers said. He also emphasized their importance to many people living in rural parts of Northwest Florida.

“Whether it’s Zika Virus, whether it’s on blood pressure or diabetes, these pharmacists are our first line of defense, as far as our health care, especially in the rural areas,” He added.

Evers says he’s been speaking with the Agency of Health Care Administration or AHCA. Evers say the agency is in contact with both Humana and Molina asking them to make an exception in their network for all independent pharmacies in the area.

Evers says they would consider a third HMO provider otherwise.

“If they don’t cooperate, then AHCA would recommend to the legislature that they do open it up for a third provider that would actually allow for our independent pharmacies,” Evers said.