State hasn’t acted, but Medicaid care companies move to pay pharmacists for medical services

A Publix Super Markets pharmacy manager retrieves a a medication in Miami. Credit: Joe Raedle/Getty Images.

The Ohio Department of Medicaid has been slow to implement a law that would enable pharmacists to be paid to consult with patients and help them manage chronic diseases such as diabetes and high blood pressure.

So increasingly, the managed-care companies that handle the vast majority of the state’s Medicaid clientele are paying out of their own pockets for the service.

Buckeye Health, one of five managed-care companies serving Ohio clients, last week announced the first phase of a program that would pay pharmacists as medical consultants. The program will start at two federally-qualified health centers: Northeast Ohio Neighborhood Health Services in Cleveland and Primary Health Solutions, in Cincinnati. Christ Hospital in Cincinnati also will participate. 

“This program expands healthcare access by increasing the level of care pharmacists can provide at a place where members are already going,” Steve Province, president and CEO of Buckeye Health Plan said in a statement. “This offers more access, more help and more support to those who often need it the most. We believe in the added value this program provides to our members so much that we’re reimbursing pharmacists participating in the program for this expanded role.”

The announcement comes after another of the state’s managed-care organizations, UnitedHealth, announced its own plan to partner with Brewster Family Pharmacy in Stark County near the edge of Ohio’s largest Amish population and Franklin Pharmacy in economically stressed Warren.

And leaders of Ohio’s biggest managed-care organization, Dayton-based CareSource, have been discussing similar concepts since last year.

The idea behind the programs is straightforward: The more effectively pharmacists monitor patients and adjust their medications, the fewer days they’ll end up spending in the hospital. That would save money for the managed-care companies and, ultimately, taxpayers.

To serve that goal, former Gov. John Kasich in January 2019 signed a law that would create a mechanism for Medicaid to pay pharmacists as care providers in addition to paying them to dispense drugs as they are now.

However, the Medicaid department is yet to implement the law, despite repeated calls from the pharmacy community and Gov. Mike DeWine emphasizing how important pharmacists are when it comes to dealing with the coronavirus pandemic.

Now the agency is saying it will implement the law early next year. 

The managed-care providers and some pharmacies aren’t waiting for that to happen.

“Pharmacists have the training and skills to do so much more than fill prescriptions, and this new initiative will allow pharmacists to demonstrate their value in today’s evolving healthcare framework,” Stuart Beatty,  associate professor of clinical pharmacy at Ohio State, said in a statement. “This program will raise the bar for how pharmacy benefits and pharmacist-provided care is delivered in Ohio.”