The Florida Pharmacy Association has filed a complaint claiming the state is unconstitutionally attempting to direct Medicaid recipients with chronic diseases to get their maintenance medications via a mail-order pharmacy program.


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Florida Rx association challenges state mail-order plan

January 26th, 2011

TALLAHASSEE, Fla. – The Florida Pharmacy Association has filed a complaint claiming the state is unconstitutionally attempting to direct Medicaid recipients with chronic diseases to get their maintenance medications via a mail-order pharmacy program.

In a complaint filed last week in the Circuit Court for Leon County, Fla., the association and member pharmacy The Prescription Place of Defuniak Springs, Fla., allege that Florida's Agency for Health Care Administration "illegally attempts to steer well over 50% of the state's chronically ill Medicaid patients away from their local pharmacies and into a single mail-order pharmacy."

The legal action focuses on a provision in 2010 state budget legislation calling for the agency to issue an "invitation to negotiate" with pharmacy providers to offer mail-order delivery services to Medicaid patients with such chronic conditions as congestive heart failure, HIV/AIDS, end-state renal disease and cancer, with the goal of helping those patients secure their prescription drugs and reducing Medicaid program costs.

According to the court document, the agency will limit the number of mail-order participants to 20,000 statewide. However, the complaint said the agency estimates that 35,000 Medicaid patients in the state would meet the criteria for the mail-order program.

"Thus, the [provision] attempts to route in excess of 50% of the state's chronically ill patients away from their existing local pharmacies and into a mail-order program which, at a minimum, deprives the patients access to a provider having extensive knowledge of their medical conditions and unique clinical problems," the complaint stated, explaining that participants would receive maintenance drugs from the mail-order program and nonmaintenance medications from another pharmacy. "This seriously jeopardizes any real opportunity for the current pharmacist of record to facilitate continuity of care and to review the patient's drug utilizations or therapies or to identify any adverse reactions of one medication with another medication."

The complaint challenges the Agency for Health Care Administration's authority to create a mail-order pharmacy program and claims such a move raises legal questions in the areas of drug therapy management, freedom of choice of health care providers and access to care for state health benefit recipients.

What's more, the plaintiffs contend the plan produces no savings for the state or the patients. "There were no legislative hearings upon the appropriateness of this drastic policy change to the manner in which chronically ill Medicaid recipients receive their maintenance drugs," the court document said. "The question must be asked as to why such was necessary when it does not represent a cost savings to the state [or] Medicaid recipients."

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