Florida’s current Agency for Healthcare Administrations (AHCA) rules state managed care plans can limit the number of pharmacies allowed to participate in their Medicaid Managed Care networks based on meeting the federal Medicare network adequacy standards. ACHA adopted these standards, which only require plans to have one pharmacy within a 30-minute travel time for patients in urban areas and a 60-minute travel time for patients in rural areas.
Notably, a pattern has occurred over the years where these health plans have restricted patients to specific pharmacies and removed all other pharmacy providers from their network, especially community and neighboring pharmacies. This restriction not only directly affects pharmacies, but it also can compromise patient care for those vulnerable citizens needing easily accessible, special pharmaceutical services.
Florida has approximately 1,300 community pharmacies that employ 12,900 people full-time. In 2014, these pharmacies filled more than 80 million prescriptions, almost half of which were Medicaid recipients’ prescriptions. In 2016, 257 community pharmacies closed their doors. These upstanding community pharmacies are small businesses in Florida that have been in these patients’ communities for generations.
Thankfully, we have legislation to fix this problem. Senate Bill 670 and House Bill 625 ensure all Floridians have access to quality healthcare without closing Florida businesses. This legislation would proactively state that no managed care plan could exclude any pharmacy that meets the quality and credentialing requirements set by the AHCA and is willing to accept the terms and reimbursements of the plan. This language also requires the Agency to promulgate rules establishing credentialing requirements and quality indicators for pharmacies.
This bill would also reinforce the current statute providing health plans the ability to limit their networks per credentialing requirements, quality indicators and price, and prevent the plans from excluding a pharmacy that meets these standards as further defined by AHCA rule.
Considering the recent actions by Staywell Health Plan and Molina Healthcare of Florida to expand their Medicaid pharmacy networks to include previously excluded small business pharmacies is a distraction from this issue. The exaggerated concerns of higher costs voiced by opponents of Senate Bill 670 and House Bill 625 are unfounded. Community pharmacies want to be able to care for patients and will accept the same reimbursement costs provided by the various Medicaid healthcare plans.
Senate Bill 670 is sponsored by Sen. Aaron Bean and House Bill 625 is sponsored by Reps. Heather Fitzenhagen and Jason Fischer. We commend the bill sponsors for their hard work and diligence as champions of great policy change. At this time, we urge our legislators, community pharmacies and the public to respectfully encourage Rep. MaryLynn Magar as the chair of the Health Innovation Subcommittee to calendar House Bill 625 on the committee agenda as soon as possible. Florida pharmacies and patients are counting on this important legislation to pass this session.