首页
外语
计算机
考研
公务员
职业资格
财经
工程
司法
医学
专升本
自考
实用职业技能
登录
外语
Independent drugstores are raising questions about the state’s effort to save tens of millions of dollars by rolling pharmacies
Independent drugstores are raising questions about the state’s effort to save tens of millions of dollars by rolling pharmacies
admin
2011-08-28
33
问题
Independent drugstores are raising questions about the state’s effort to save tens of millions of dollars by rolling pharmacies into Medicaid managed care.
Not long after the state rolled pharmacies into Medicaid managed care in March—an effort to save tens of millions of dollars a year—Ronald Barrett noticed something unusual at his store, Oak Cliff Pharmacy in southern Dallas. When he entered a child’s prescription into his computer to see how much he would be reimbursed by CVS Caremark, the managed care plan’s pharmacy benefit manager, he got an error message. A phone call indicated that the prescription had already been filled, at a CVS pharmacy down the road.
"I asked the child’s mother, ’Did you have the prescriptions sent over there?’ And she said, ’No, I don’t even go over there,’ " said Mr. Barrett, most of whose customers are covered by Medicaid, the state and federal health plan for the disabled and poor."We called the prescriber, and they said they didn’t know how they got over there either."
Another pharmacist, in Harlingen, received a fax from a health plan managed by CVS Caremark rejecting a claim for diabetic test strips with the message, "Please route patient to a CVS pharmacy."
Such stories have fueled suspicions among independent pharmacies that CVS Caremark is capitalizing on Medicaid changes to expand its retail business at the expense of locally owned pharmacies. CVS Caremark, which this spring became one of seven pharmacy benefit managers handling Medicaid recipients’ claims, said that its rates are competitive and there is a firm barrier between its benefit management program and CVS retail pharmacies.
The transition to managed care this spring was bumpy, with numerous computer errors and miscommunications between the State Health and Human Services Commission, pharmacists and the pharmacy benefit managers.
Although the state said that the program has become more stable and that the health plans quickly resolved the problems, many independent pharmacists—particularly those who serve a high volume of Medicaid patients—are still upset. They say the drastically reduced reimbursement rates set by the managed care plans to save the state money are forcing them out of business.
"I can’t pay my employees; I can’t pay my light bill," said Mr. Barrett, who estimated that the overhaul decreased his revenue by 65 percent. He is currently living on his savings, he said. "I have no earthly idea why the Legislature thinks that this is acceptable."
Texas lawmakers, who expect to save $100 million in the 2012—13 biennium by including prescription drugs in managed care, have held hearings to address pharmacists’ concerns. The Health and Human Services Commission is conducting an audit to evaluate the reimbursement rates.
Under the old Medicaid system, the rates were the same statewide. Now, pharmacists sign managed-care contracts agreeing to accept the "maximum allowable cost" reimbursement for medications, as determined by the health plan’s pharmacy benefit manager. Because the rates are proprietary information and are not subject to open-records laws, pharmacists do not know before signing a contract how much a health plan will reimburse or how its rates compare with those of other plans before signing a contract.
Stephanie Goodman, a spokeswoman for the commission, said that the decrease in reimbursement rates is "very much in line" with what the agency expected, and that it is the same for independent and chain pharmacies. The average dispensing fee paid to pharmacists for Medicaid prescriptions dropped from $7.13 to $1.53 in the new system, and pharmacists received $12.7 million less in dispensing fees in the first month than they would have under the previous system.
John Calvillo, president of the Rio Grande Valley Independent Pharmacy Association, said he has a list of 26 independent pharmacies that have closed or been sold to retail chains since the managed care changes. He said that CVS Caremark is largely to blame because it has the lowest reimbursement rates of the five managed care plans he accepts. And, he contended, it appears to be trying to poach independent pharmacies. "In my opinion, it’s kind of a little conspiracy and the state is allowing this to happen," Mr. Calvillo said.
From The New York Times, June 15, 2012
By "bumpy", the writer tends to say______.
选项
A、the changes were not smooth
B、computers did not work
C、some governmental sectors were not well-informed
D、there were misunderstandings between pharmacists and the pharmacy benefit manager
答案
A
解析
本题为细节题。文章第六段告诉我们向管理式医疗过渡困难重重,例如电脑信息错误以及联邦卫生与公共服务部、药剂师和药品福利管理者之间信息错误传达,因此应该选择A。
转载请注明原文地址:https://kaotiyun.com/show/7lYO777K
0
专业英语八级
相关试题推荐
TheOpenUniversitywasestablishedin1969toprovidedegreecoursesincorrespondenceforstudentsof21yearsandover,
A、ManyPalestinianhousesweredestroyed.B、Dozensofpeoplewerekilled.C、Theraidlastedforalmostaweek.D、Themissionof
A、comefromalargefamilyB、wanttobeshoutedatC、getenoughattentionD、liketosumotherothersupC
Countriesatalllevelsofeconomicdevelopmentfaceasimilarchallenge:tomaketheirindustriescompetitiveinanincreasingl
InthedaysbeforeDianabecameaccustomedtodailyhairdressers,highfashionandexpertlyappliedmakeup,shelookedherbest
ThewritingoftheConstitutionoftheUnitedStatesisanactofsuchgeniusthatphilosophersstillwonderatitsaccomplishme
A、moreindependentB、hisownbargainingagentC、lessindependentD、moretroublesomeC
A、Morethan8,000,000dollars.B、Morethan15,000,000dollars.C、Morethan50,000,000dollars.D、Morethan25,000,000dollars.
NowadaysinChina,somefamousathletesandentertainersearnmillionsofdollarseveryyear.Doyouthinkthesepeopledeserve
Thereisnowaytolearnthematerialforcollegecoursewithoutspendingtimeandeffortinstudying.Thereisnomagicformula
随机试题
奴隶社会和封建社会的法制()。
下列关于测绘资质年度注册时间的说法,不正确的是()。
背景某施工单位承建两栋十五层的框架结构工程。合同约定:①钢筋由建设单位供应;②工程质量保修按国务院279号令执行。开工前施工单位编制了单位工程施工组织设计,并通过审批。施工过程中,发生下列事件:事件一:建设单位按照施工单位提出
甲公司采用分期收款方式销售商品给乙公司,1月10日发出商品1000件,价款总计500万元,销售成本率为80%,增值税税率为17%。合同约定当日支付40%的合同价款,余款分3年于每年12月31日支付,该笔价款的公允价值是450万元。假定甲公司在合同签订当日
A公司2007年12月31日资产负债表中有关项目账面价值及其计税基础如下:交易性金融资产账面价值为1500万元,计税基础为1000万元;预计负债账面价值为100万元,计税基础为0万元;除上述项目外,该企业其他资产、负债的账面价值与其计税基础不存在差异,且递
若某一经济的价格水平2005年为107.9,2006年为111.5,2007年为114.5。问2006年和2007年通货膨胀率各是多少?若人们对2008年的通货膨胀率预期是按前两年通货膨胀率的算术平均来形成。设2008年的利率为6%,问该年的实际利率为多少
《刑法》第384条规定:国家工作人员利用职务上的便利,挪用公款归个人使用,进行非法活动的,或者挪用公款数额较大、进行营利性活动的,或者挪用公款数额较大、超过3个月未归还的,是挪用公款罪……试分析挪用公款罪的构成特征。
Everyindividualpossessesauniquequalitythatdifferentiateshimorherfromotherpeople.Whetheritisacharmingpersonali
系统为了管理文件,设立了专门的数据结构—文件控制块(FCB)。FCB是在执行下列哪一个系统调用时建立的?
有以下程序#includevoidmain(){intc=0,k;for(k=1;k<3;k++)switch(k){default:c+=k;
最新回复
(
0
)