Commissioners Court - Regular Session

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31.

Meeting Date:	12/15/2009
Submitted For:	Bride Roberts	Submitted By:	Bride Roberts, Health District
Department:	Health District

Agenda Item

Consider option to contract with LSCC to provide primary care and pharmacy services to the WilCo Care program, paying LSCC at the allowed Medicaid encounter rate.

Background

As an FQHC, LSCC purchases medications at the highly advantageous 340B rate, far below any market cost that can be achieved by commercial vendors. A sample of WilCo Care pharmacy data has been re-priced under the proposed 340-B pricing. Analysis indicates that an average of 40% savings on prescription drugs provided to those patients may be expected, compared to current rates under the contracted PBM. Up to 50% cost reduction is possible. It appears that the added cost of continuing to pay LSCC at Medicaid encounter rate for primary care visits would be more than offset by these cost savings to the WilCo Care program, and may save the county money overall. At 40% estimated savings, projected reduction in pharmacy costs is $205,200. Projected loss to LSCC from the primary care rate change: $175,000.

Implementation:
• LSCC would become a WilCo pharmacy provider,
• WilCo Care patients assigned to LSCC would be instructed that LSCC is their preferred pharmacy provider, and that additional medications beyond the 3/mo paid by this program may be purchased at low price through their pharmacies.
• Current Pharmacy Benefits Manager Ideal Scripts would process all claims for payment, and
• Ideal Scripts would be instructed to pay all LSCC pharmacy claims at the billed 340B pricing rate, no re-pricing required.

No new eligibility cards would be required for members, and members who have serious transportation issues may continue to fill their meds at pharmacies in their home areas. This would, it is expected, affect a very small number of members. This would also allow any WilCo Care patient who receives services at LSCC, regardless of PCP assignment, to fill medications in their pharmacy. No extra costs are expected related to implementation.

Fiscal Impact

From/To	Acct No.	Description	Amount

Attachments
Rx program cost projections

Form Review

Inbox	Reviewed By	Date
County Judge Exec Asst.	Wendy Coco	12/10/2009 10:56 AM
Form Started By: broberts		Started On: 12/08/2009 09:05 AM
Final Approval Date: 12/10/2009