Florida House Bill 625 Regarding Managed Care Plan Provider Networks:
Florida House Bill 625 was introduced and filed in the Florida State Senate in March 2017 and is now in committee/council (HIS). Many independent community pharmacies in Florida are strongly advocating for the bill as it relates to the current Managed Care Plan Provider Networks. Essentially HB 625 would prohibit a managed care plan from excluding any participating pharmacy that meets the credentialing requirements and standards established by the Agency for Health Care Administration (AHCA) and that accepts the terms of the plan. It also basically requires all managed care plans to offer the same rate of reimbursement to all pharmacies in the plan network.
Issues With the Existing Managed Care Plan Provider Network Rules:
Most independent community pharmacies are strongly in favor of the new rules. As many see it, the problems with the existing rules are that they are restrictive to what are considered “industry fair practices” and result in the patient facing limited options or choices in getting their prescriptions filled. To sum up the issues, the advocates of the new Florida House Bill 625 point out the following existing issues:
– The current rule allows Medicaid managed care plans to limit the pharmacies allowed in their Medicaid Networks based on meeting Federal Medicare network adequacy standards.
– AHCA adopted federal Network access standards currently only require plans to have a pharmacy within a 30-minute travel time for patients in urban areas and a 60-minute travel time for patients in rural areas. This access standard creates a hardship for Medicaid recipients who have limited transportation and resources.
– These closed networks have forced consumers to leave their local pharmacies that many Medicaid recipients often rely on for an array of medical services, advice and assistance.
– Several plans have negotiated pharmacy services using only 2 or 3 chain pharmacies, thus excluding hundreds of local Florida based pharmacies from participating in the Medicaid program.
Many organizations have rallied behind the proposed new Florida House Bill 625. An example is the Florida Independent Pharmacy Network (FIPN) who has been strongly urging that proponents of the bill to take action and reach out via phone &/or email. Below is a list supplied from FIPN regarding the contact information for the Speaker of the House, the Committee Chairs and the Committee Members:
Representative Richard Corcoran (Speaker of the House)
District Ph: (813) 792-5177 – Capitol Ph: (850) 717-5000
Representative Travis Cummings (Health & Human Services Committee Chair)
District Ph: (904) 278-5761 – Capitol Ph: (850) 717-5018
Representative MaryLynn Magar (Health Innovation Subcommittee Chair)
District Ph: (772) 545-3481 – Capitol Ph: (850) 717-5082
Health Innovation Subcommittee Members:
Representative MaryLynn Magar – District Ph: (772) 545-3481 – Capitol Ph: (850) 717-5082
Representative Shawn Harrison – District Ph: (813) 910-3277 – Capitol Ph: (850) 717-5063
Representative John Cortes – District Ph: (407) 846-5009 – Capitol Ph: (850) 717-5043
Representative Daisy Baez – District Ph: (305) 442-6825 – Capitol Ph: (850) 717-5114
Representative Manny Diaz, Jr. – District Ph: (305) 364-3072 – Capitol Ph: (850) 717-5103
Representative Brad Drake – District Ph: (850) 951-0547 – Capitol Ph: (850) 717-5005
Representative Nicholas Duran – District Ph: (305) 860-7119 – Capitol Ph: (850) 717-5112
Representative Roy Hardemon – District Ph: (305) 795-1224 – Capitol Ph: (850) 717-5108
Representative Patrick Henry – District Ph: (386) 238-4650 – Capitol Ph: (850) 717-5026
Representative Sam Killebrew – District Ph: (863) 291-5254 – Capitol Ph: (850) 717-5041
Representative Paul Renner – District Ph: (386) 446-7644 – Capitol Ph: (850) 717-5024
Representative Bob Rommel – District Ph: (239) 417-6200 – Capitol Ph: (850) 717-5106
Representative Jackie Toledo – District Ph: (813) 281-5549 – Capitol Ph: (850) 717-5060
Representative Jay Trumbull – District Ph: (850) 914-6300 – Capitol Ph: (850) 717-5006
Representative Frank White – District Ph: (850) 595-0467 – Capitol Ph: (850) 717-5002