Upcoming Pharmacy Service Changes Will
Decrease Cost, Increase Efficiency
LANSING - The Michigan Department of Community Health has announced pharmacy service changes for the upcoming Michigan Managed Care Request for Proposal, which affects Medicaid patients.
The goal of the new changes is to streamline administration for health care providers.
Among the changes is a shift from multiple formularies to one.
A formulary is a list of three to five similar medications. The actual prescription a that the pharmacy carries and the patient receives depends on what insurance covers.
Changing to a single formulary will increase efficiency and decrease costs for providers and patients. This is in contrast to the confusion-and even health risks of patients-caused by the old system.
"Traditionally, when a medication or prescription is sent over to the pharmacy, the pharmacy attempts to bill it to the patient's insurance, and if it's not covered, the pharmacy needs to get a hold of the physician and this causes a delay in care," said Jeff Ackerman, Pharm D, of PGPA Pharmacy in Okemos. "So, it doesn't help the health of the patient to have these delays in care."
Pharmaceutical services for Medicaid beneficiaries in Michigan will be done through a single entity beginning in January 2016. The newest request for proposal will be released May 1.
Michigan also hopes to be able to cover Medicaid dental services for adults, including those currently covered by the Healthy Michigan Plan, through a managed care contract slated to begin in July 2016.