Concerns Raised Over Marin County’s Shift to Medi-Cal Managed Care
Patient advocates and independent pharmacists are expressing concern as Marin County prepares to shift the majority of its Medi-Cal beneficiaries to a managed care organization called Partnership HealthPlan of California, the Marin Independent Journal reports. Medi-Cal is California's Medicaid program.
The Marin County Board of Supervisors approved the plan to move Medi-Cal beneficiaries to managed care as part of an effort to curb costs and improve patient care. The transition will take effect July 1.
Of the approximately 23,000 Medi-Cal beneficiaries in Marin County, about 16,000 will be affected by the change. Most of the Medi-Cal-eligible residents who will not enroll in Partnership HealthPlan are undocumented pregnant women.
Advocates Voice Concern
Patient advocates are concerned that Medi-Cal beneficiaries who are transitioning to managed care might face challenges receiving coverage for their prescriptions. In addition, some independent pharmacists are concerned that the transition will lower their Medi-Cal reimbursements.
William Remak, who serves on the steering committee of the California Chronic Care Coalition, said the new managed care enrollees might face challenges in receiving coverage approval for brand-name drugs.
Gary Louie, pharmacy service director for Partnership HealthPlan, said, "Every FDA-approved medication is potentially available to our patients, but we do have a formulary that is generic-based." He added, "Therapeutically similar generic medications will have to be used prior to access to a brand-name drug" (Halstead, Marin Independent Journal, 6/19).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.