Pharmacists voice concerns over reimbursements rates in new managed care system


LITTLE ROCK, Ark. – A new system changes how Medicaid is billed for about 50,000 Arkansans with severe mental illness or developmental disabilities. 

The Arkansas Department of Human Services (DHS) shifted to a managed care system on March 1 for these individuals. 

Three companies, known as PASSEs, are now responsible for paying for members’ Medicaid services. 

The COO of the Arkansas Pharmacists Association, John Vinson, said some claims still cannot be processed because of delayed patient ID cards or incorrect addresses.

“Those will be worked out in the next couple weeks,” Vinson said. “I know DHS and Medicaid, the pharmacy program and their PASSE team have been working very hard, working extended hours.” 

On day four of the new system, Vinson worried what will take longer to resolve is an issue with the entities the PASSEs hired to process the claims.

“The pharmacy benefit managers (PBMs) are paying below costs for the pharmacies to buy the drug and to operate,” Vinson said. “That’s a much bigger challenge, and I’m not sure when the resolution will occur on that.” 

The Arkansas Insurance Department now regulates PBMs, the middlemen between pharmacists and insurance providers. Last year, pharmacists blamed them for drastic cuts to their reimbursement rates, prompting the new law.

“It’s too early to tell yet exactly where the issues are, but we’re diving in to figure that out,” Vinson said. 

If patients have not received their ID cards, DHS said they can still receive services from their provider with their Medicaid ID. For more information on the new system, visit the DHS website.

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