TEXAS RETHINKS REIMBURSEMENT POLICY FOR COGNITIVE SERVICES

AUSTIN, Texas -- Texas pharmacists have moved a step closer toward claiming reimbursement for providing education and training to Medicaid patients with diabetes.The Texas Pharmacy Association has reached an agreement with the Texas Department of Health, both based here, to allow pharmacists in the state to establish demonstration projects that would allow reimbursement for cognitive services."That's

AUSTIN, Texas -- Texas pharmacists have moved a step closer toward claiming reimbursement for providing education and training to Medicaid patients with diabetes.

The Texas Pharmacy Association has reached an agreement with the Texas Department of Health, both based here, to allow pharmacists in the state to establish demonstration projects that would allow reimbursement for cognitive services.

"That's an exciting development. That kind of recognition is encouraging to pharmacy as we try to move away from product-based reimbursement," said Lee Roy Treadway, director of pharmacy for Minyard Food Stores, Coppell, Texas.

The reimbursement formula should take effect Sept. 1, when the Texas regulations are expected to become effective.

"It's encouraging to see that someone who is a large payer (Medicaid) is willing to pay for these services," commented Glen Davis, vice president of pharmacy at Randalls Food Markets, Houston. "We hope other third-party payers follow this lead. I feel confident that this type of program will demonstrate that pharmacists will reduce overall medical expenditures."

"By providing a little incentive to pharmacists to engage in those cognitive services, the state can save substantial amounts of money," said Paul F. Davis, executive director of the TPA. As to how much pharmacists will be reimbursed, that will be determined by the regulation, he said.

Cognitive services lower health care costs, Davis continued. "Any type of educational training or information provided to diabetics where they improve their compliance with their therapy will save total health-care dollars.

"For instance, if pharmacists remind diabetics to get retinal exams, they are more likely to be caught before they develop further cardiovascular complications. Or, if pharmacists show patients how to take care of their circulation in their feet, they can avoid having amputations," Davis of the TPA said.

Lobbying efforts on the part of the TPA and the Texas Federation of Drug Stores were also partly responsible for the passage of a new reimbursement formula for Texas pharmacies dispensing prescriptions to Medicaid patients.

Reimbursement rates will increase from $4.55 to $5.27 as of Sept. 1, subject to the rule-making of the Texas Department of Health, the TPA's Davis pointed out.

"It sounds like a reasonable and fair fee," Davis of Randalls said.

Treadway also thought it was a fair resolution. "It represents a compromise. It is an increase in fees, but the overall reimbursement is a reduction and is designed to save the state some money."

Davis of the TPA said he assumed the legislation will become effective Sept. 1 because it is the start of the state's fiscal year. "That's also when laws passed in this session of the legislature take effect and that's also the earliest time that it could physically be done, given the Texas Administrative Procedures Act."

He said the increase in reimbursement fees for pharmacies is significant because going into the legislative session, the Department of Health had actually proposed lowering reimbursement.

"There would have been no opportunity for profit if they had lowered fees. It would have meant selective contracting so that the lowest bidder in each area of the state would have been the only Medicaid provider," Davis of the TPA said.

If reimbursement fees had been reduced, which was not the case, pharmacies may have had to close because they would have been "locked out" of the Medicaid program, he said. Some food stores in Texas may also have had to consider closing their pharmacy departments.