A pharmacy manager retrieves a a medication. Credit: Joe Raedle/Getty Images.
The Ohio Department of Medicaid is struggling to implement a system to reimburse community pharmacists to test millions of the state’s poorest people for coronavirus.
While the reasons for the problems have not been fully explained, difficulty getting supplies appears to be one.
But another cause might be that at least into June, senior leaders at the agency appear to have communicated little about creating a plan. And many of the emails they did send seemed to resist doing so, according to records obtained by the Capital Journal.
In one instance, a Medicaid official even asked about creating a strategy to deny payment to pharmacies. He raised that possibility on May 11 — more than a month before the Medicaid department had even established a reimbursement rate.
In an interview last week, Medicaid Director Maureen Corcoran said those emails were being taken out of context. But when repeatedly asked for that context and offered more time to provide it, she declined.
“I think you’ve made it clear how you view it,” Corcoran said.
Ohio officials and others have for months been calling on the state’s pharmacies to participate in coronavirus testing — particularly of Medicaid patients who often have transportation challenges that make their local pharmacy easier to get to than a hospital or the county health department.
But with August beginning, the $27 billion-a-year agency hadn’t reimbursed any of Ohio’s thousands of pharmacies for a single coronavirus test, The Columbus Dispatch reported last week.
That was almost four months after the U.S. Department of Health and Human Services had issued guidance on how pharmacists could conduct coronavirus tests.
“In an effort to expand testing capabilities, we are authorizing licensed pharmacists to order and administer COVID-19 tests to their patients,” HHS Assistant Secretary for Health Brett P. Giroir said in a written statement accompanying the guidance. “The accessibility and distribution of retail and independent community-based pharmacies make pharmacists the first point of contact with a healthcare professional for many Americans.”
But at Ohio Medicaid, a $27 billion-a-year agency that serves 2.8 million Ohioans, officials seemed reluctant to come up with a way to pay pharmacists for coronavirus tests.
“Interesting…. I suppose whether we like it or not, this is coming and we’ll need to start preparing for it,” Medicaid Pharmacy Program Manager Tracey Archibald said in an email to other officials. The message contained a link to a Nevada memo about a waiver to pay pharmacists for such testing.
Four days later, on April 14, Archibald shared a Johns Hopkins University paper about a national testing and tracing strategy with her colleagues and expressed a possible change of heart.
“Nice. I saw this update from HPIO and I think I am changing my tune about pharmacies providing testing…,” she wrote.
But just a day later, on April 15, Medicaid pharmacologist Sean Eckard raised concerns about the danger of potentially infected Medicaid patients showing up at their local pharmacy for coronavirus testing.
“I just cannot get over the thought of having potentially infectious/biohazardous materials being handled by the same people handling medications for especially vulnerable populations,” he wrote. “Even if drive-through testing is done, the specimens will have to be brought inside and handled by the pharmacy staff.
“Regardless of the above ‘ick’ factor, it sounds like it will definitely be happening. The train has left the station on this one.”
Those concerns don’t seem to take into account that, as Giroir said, the pharmacy is already “the first point of contact” in the health system for many — especially when they feel sick.
Gov. Mike DeWine on May 1 started easing COVID-19 restrictions despite a lack of testing. On May 11, Medical Director Donald Wharton sent an email to colleagues saying he had heard about rules changes that would allow pharmacies to be paid by Medicaid to perform tests.
“Do we need a statement or strategy to deny payments?” he asked
Later the same day, Medical Director Mary Applegate emailed her colleagues and expressed her own reservations testing at pharmacies.
“It sounds like you are getting even more pressure for us to PAY pharmacists to do Covid-19 testing,” she wrote.
Applegate later added: “Am elevating this to (Corcoran) as adding hundreds of pharmacy sites with the troopsing in of infected people at sites that may not be prepared with sufficient sanitation, donning/doffing space, personnel and PPE may add to the existing confusion.
“Am extra worried about the SICK people that come just to pick up their meds for hypertension and diabetes and kidney failure…”
The Medicaid department on June 3 was asked for all emails among department employees about paying pharmacists for coronavirus testing since Feb. 1. On July 30 — almost two months later — department attorneys responded with just 25 emails. They added that the communications concerned paying “pharmacies” for the tests as opposed to “pharmacists.”
In an interview last week, Corcoran made much of the distinction.
First she questioned whether the communications concerning the so-far failed coronavirus testing plan were even a story.
“Is that something that you would want to put in some kind of a published article?” Corcoran asked.
Then she said she felt “very strongly” that it was wrong for the Capital Journal to name the senior Medicaid officials who wrote the emails.
Then Corcoran emphasized her agency’s generosity in providing emails concerning payments to “pharmacies” instead of “pharmacists.”
“I’m going to caution you,” she said. “We tried — as evidenced by this request — we tried to go the extra mile even though (the department had received) records requests that were not lawful.”
The Medicaid director said that “given your answers” she might feel the need to rethink her agency’s “interactions with you as it relates to records requests and freedom of information.”
Corcoran, however, demurred when asked to comment on whether the department had taken its job seriously enough when it comes to testing Medicaid patients for coronavirus in Ohio’s 2,000-plus pharmacies.
“I just made a categorical comment in that regard and if you have any other questions, feel free to submit them to us in writing,” she said.
The controversy over testing isn’t the only one faced by Corcoran’s department.
On Sunday, The Columbus Dispatch reported that Corcoran and other Medicaid officials falsely said last year that there were no earlier versions of an analysis of drug pricing. Earlier versions of the report obtained by the paper showed that the final version had removed about a dozen tables of data regarding the billions the agency spends on drugs.
Confronted with the discrepancies, Corcoran released a written statement saying it was “incorrect” that she had made false statements about earlier drafts of the report. Now Ohio lawmakers are threatening to subpoena additional information.
Similarly, Medicaid officials responded falsely on two occasions last year when asked if they had been notified that Walgreens was leaving the network of the state’s largest Medicaid managed-care provider. The notification, which came on the eve of open enrollment, represented a major contraction in the pharmacy network of Dayton-based Caresource.
On April 8, early on in the struggle against the new coronavirus, public health officials knew that a wide testing network was key to getting control of the outbreak of the highly infectious disease.
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