Travis County Commssioners Court
September 30, 2003
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Item 34
34, consider and take appropriate action regarding the federal 340 b drug pricing program.
>> if that one wasn't easy, I know this one won't be. What we're asking you to do is to really reconsider how we're providing pharmaceuticals to our medical assistance program patients. We have a program where if you are in our medical assistance program, you basically can get your meds at private pharmacies. The federal government has a drug program called a 340 b drug pricing program. Because we are a federally qualified [inaudible] center and we have an opportunity to access lower cost pharmaceuticals. But in order to do that, we will essentially have to change the design of our benefits to some extent. One aspect of our current eligibility guidelines is that you can actually be an immediate care patient going to a private physician and actually we would provide pharmaceuticals for you. But the 340 b drug pricing program, one of the criteria for our accessing drugs through that program is that the person that's being served has to have a primary care provider within our system. And so therefore I'm coming to you with a couple of recommendations and they are indicated by a, b and c on the front page of my memo. We're hoping -- I'm asking that you change our m.a.p. Policy so that all enrollees, medical home or primary care provider will be restricted to one of the Travis County network providers. That would mean that everybody that's in our program that would access this pricing would have to be a client within our clinics. We also would ask that because they are locked in our clinic, that we will give them unlimited prescription benefits. We're able to do this because of the lower price. And also, c, our m.a.p. Enrollees be limited to filling prescriptions at a single pharmacy [inaudible]. The plan is to have the clinic system be affiliated with one pharmacy, for instance, h.e.b. Or eckerd's, so there will be multiple service points. And the clients would, in essence, receive their medicines from either the pharmacy that is are inside the clinics or in a pharmacy that we have a contract with to provide medication, drug benefits.
>> steven, in essence, the participants, whether they are primary care physician or the pharmacies that are a part of the network that we encourage in our [indiscernible], the 340 b programs have been established with all of these participants whether it be the pharmacies and also the private care physicians that also be a part of that? In other words you, as far as who we could pick as far as [indiscernible]?
>> to answer the question -- would you ask your question again. I can't hear it.
>> I was asking that the pharmacy to get the reduced drugs in this particular pharmacy drug program, the participating pharmacist and also the private care physicians, those that are participating with this federal program, the 340 b program, they are all on board, these are the ones that we're encouraging those folks to choose because it is basically a reduction in the cost of the pharmacies?
>> no, really --
>> what else? There's an advantage, isn't there?
>> what worry doing is saying you have to be a client of the clinic system in order to access unlimited prescriptions. And because we're accessing this federal -- and this is a federal requirement. What we're saying is that in order for you to access this benefit, you have to be one of our patients. Which would limit their choice of primary care providers.
>> well, it sounds like it's simply consolidating the pharmaceuticals by having to go through our clinics or our program, and it's just like the program that employees have, isn't it, more or less? I mean there's a restriction to one place to get your medicines, but other than that, I don't see a -- they still have the alternative of h.e.b. And our pharmacies.
>> they have that alternative, but in order to access drugs, they will have to see our doctors.
>> right. [multiple voices]
>> I don't see a problem with that.
>> what's the situation today?
>> the situation today is that, as I explained earlier, an individual can see a primary care provider outside of our clinic system, and we basically provide drugs for them. But in order for us to access the 340 b program, they would have to actually change primary care providers, see one of our doctors. And then they are able to access the 340 b program.
>> so right now some clients are eligible for clinic participation.
>> uh-huh.
>> but have chosen to have their physicians outside our network.
>> yes.
>> and we have approved that.
>> yes, have you.
>> and these outside of our network physicians basically prescribe medication.
>> yes.
>> and they go to any pharmacy and get the prescription filled?
>> yes.
>> do we have any idea about what number that is?
>> yes. 334. Actually I remembered that one.
>> 334?
>> 234.
>> 234.
>> there are 234 medicare patients who receive prescription benefits through the medical assistance program and dental services only. And -- well, who are currently using private providers. We have many, many more who are receiving services through our clinics through the clinic physicians, but 234 of our medicare enrollees, their primary care providers are outside our system.
>> so [indiscernible] we say basically if you want us to pay for your medication, you have to come to the clinic first.
>> yes.
>> now, do we know that we will have physicians available to meet their medical needs?
>> yes. I've talked with the -- the primary care department, and we should be able to accommodate that increased workload.
>> I'm not worried so much about the workload as the services required. I'm visualizing clients --
>> from a my marry care standpoint,-primary care, yes, we have the physicians to provide.
>> if a physician says oops, this is not my area, will a referral be made outside the network?
>> yes, they will, but in terms of the cadre of physicians we have on board, family practice physicians are internists for the most part. We have primary care physicians. If it is something that is outside the realm of their practice, certainly they will be referred to a specialist [indiscernible] a contract that you just approved with brackenridge hospital.
>> so it's comprehensive. I mean, you are not going to find that you can't see the appropriate physician that you need. And basically what this thing does sit just narrows the flexibility that people have, but in order to gain that or for to us gain the 30% savings, this is what we have to do, we have to narrow the flexibility.
>> yes. We're narrowing choice of my marry care providers.
>> and your assurance or assurances today are, one, that we have sufficient physicians available to meet this additional 234 people. That they provide the kind of services that these need. Three is that if they don't provide those services, a referral will be made.
>> yes.
>> and when we tell these 234 people who call us, and they will, we'll be telling the truth when we [inaudible].
>> we'll be telling the truth.
>> I will tell them to call you, steven.
>> you are going to do that anyway.
>> motion approved and seconded. Any more discussion.
>> quick clarification. I'm glad the sheriff is here. When you say in your backup health care facilities are certified as covered entities, does that also include our jail health care centers in terms of them having access to the pricing structure?
>> no.
>> can we get eckerd's to make house calls? I mean that just seems unbelievable that we would have one of the biggest health care centers involving indigent, because believe me, if you have money, you are not going to be sitting in jail awaiting your case, and somehow we're not certified as a eligible point.
>> the federal government does a very good job of making sure that once people are incarcerated, that the cost of their medical care shifts from the federal government to the local government. As far as the eckerd's issue, as far as pharmaceuticals, we actually -- w-f our own pharmacist -- we have our own pharmacist that we employ or contract with at the sheriff's office and purchase our farm sat pharmaceuticals at a very good rate. We're dealing with that issue. In fact, I don't know what the cost is under this program but I know as far as our folks I know we get it for far less than if we were having to purchase them at eckerd's or h.e.b.
>> any more discussion in all in favor say aye? That passes by unanimous vote with Commissioner Daugherty temporarily away from the dais.
Last Modified: Tuesday, September 30, 2003 7:52 PM