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
23
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
The experiences of independent pharmacies caused them to______.
选项
A、suspect the intention of changes
B、expand their business
C、go on a strike
D、capitalize on Medicaid changes
答案
A
解析
本题为细节题。文章第五段第一句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.指出计划改革对独立药店的冲击使他们越来越怀疑CVS公司以私人药店为代价,利用医疗补助计划改革来扩展自己的零售业务。因此应选择A。
转载请注明原文地址:https://kaotiyun.com/show/zeYO777K
0
专业英语八级
相关试题推荐
Itisfrequentlyassumedthatthemechanizationofwork-hasarevolutionaryeffectonthelivesofthepeoplewhooperatethene
EconomicconditionshaveimprovedduringthepastdecadeinmanyNorthAmericanandEuropeanCBDs,primarilybecauseofanunp
Iammoreofahostthanaguest.Ilikepeopletostaywithmebutdonotmuchcareaboutstayingwiththem,andusually【1】_
InthedaysbeforeDianabecameaccustomedtodailyhairdressers,highfashionandexpertlyappliedmakeup,shelookedherbest
FashionWiththeprogressionofthehumansociety,peopleareincreasinglydemandingtheirclothestobebeautifulaswellas
A、abettertreatmentoftheUSdetaineesatGuantanamoBay.B、anindependentjudicialbodytobringthedetaineestotrial.C、th
ReligioninAmericanLifeDiversityisthechieffeatureofreligionintheUnitedStates.AlthoughChristianityhasalways
Cosmologyissometimespooh-poohedasmorephilosophythanscience.Itasksdeepquestionsaboutnaturebutprovidesunsatisfyin
SomehearteningstatisticswerereportedlastyearbytheJournaloftheNationalCancerInstitute:themortalityrateforbreas
SomehearteningstatisticswerereportedlastyearbytheJournaloftheNationalCancerInstitute:themortalityrateforbreas
随机试题
8岁,男孩。左膝肿痛,活动剧痛,急骤加重,伴有高热。检查左膝关节明显红、肿、热及压痛。X线片示左膝关节间隙增宽。本例最佳治疗方法是
A.输血B.泼尼松C.雄性激素D.免疫抑制剂E.切脾男性。51岁。全身皮肤黏膜黄染2个月。无出血倾向。Hb60g/L,网织红细胞15%,抗人球蛋白试验(Coombs试验)阳性,有少许球形红细胞。首选治疗手段为
下列哪一组都是糖酵解过程中的关键酶
公式∑(施工机械台班消耗量×机械台班单价)是()的计算公式。【2005年考试真题】
首席风险官应当具有良好的职业操守和专业素养,及时发现并报告期货公司在经营管理行为的合法合规性和风险管理方面存在的问题或者隐患。()
银行业从业人员李某因请假离岗,为了不影响正常业务开展及应急需要,将自己保管的印章等交予同事,体现了李某的大局意识。()
公路运输中的短途运输是指运输里程在()km范围内。
下列关于我国地方性法规的表述,正确的是:
以下属于容器类控件的是()。
Somepeoplemayovereatbecausethey’reunabletotasteand【B1】______thefatinfoods,newresearchsuggests.Peoplewhosemouth
最新回复
(
0
)