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Local pharmacists have been in battle with the health plan since OptumRx launched its program as Gold Coast’s new pharmacy benefit manager.
Anthony Wright, executive director of the nonprofit Health Access California, cites an expected $6.1 billion surplus he said could have been used to move California toward universal health care coverage. Instead, health spending only gets a modest bump in Gov. Jerry Brown’s proposed budget.
“If Bobby doesn’t have this medication, he will die. It’s as simple as that,” said Tracy Belt, a mother who has a son with Type 1 diabetes. Congress has passed a short-term funding fix for the Children’s Health Insurance Program, but lawmakers are stills squabbling over how to pay for a longer-term solution.
The state has already eliminated legal residency requirements for Medicaid coverage for people under 19. But Assemblyman Phil Ting, who heads the Assembly’s budget committee, wants to extend that to all ages.
Pharmacists have for months said the new reimbursement rates that were established after OptumRx took over control of reimbursement as the new pharmacy benefit manager for the Gold Coast Health Plan’s medication program are far below what they need to stay afloat.
The pharmacists want Gold Coast Health Plan to use its leverage to persuade OptumRx, which runs the plan’s pharmaceutical efforts, to renegotiate its rates.
CMS Administrator Seema Verma spoke about changes she wants to see to Medicaid, as well as the lack of providers accepting Medi-Cal and Medicare in Stanislaus and San Joaquin counties due to low reimbursement rates.
While hospice care is already covered by Medi-Cal, palliative care won’t be until next year. Some residents, however, are getting early access through a pilot program.
The Department of Health Care Services will oversee a consultant-led study to look into what other states have done, financing options and other issues.
Efforts to renew the popular program have stalled in Congress.