Medicaid managed care companies defend their efforts in Kentucky

jcheves@herald-leader.comFebruary 13, 2012 

FRANKFORT — Three companies hired last year to manage most of the state's Medicaid program on Monday defended their efforts and said they're working to resolve problems.

Lawmakers on the Program Review and Investigations Committee quizzed executives with Coventry Cares, Kentucky Spirit and WellCare of Kentucky, which manage Medicaid outside of the Louisville area under a cost-cutting plan implemented in November by Gov. Steve Beshear.

"Like with any new transformational program involving significant changes, unanticipated problems both major and minor will occur," said Jim Giardina, vice president for pharmacy services at Coventry Health Care. "We are committed to fixing these problems as quickly as possible, and we will listen and work with the affected parties to address their issues and concerns."

Lawmakers questioned the executives and their partners at three pharmacy-benefits companies about complaints lodged by Kentucky pharmacists, dozens of whom attended Monday's hearing.

The companies said they try to authorize prescriptions and decide appeals about denied prescriptions within days, not wanting to create unreasonable delays.

Pharmacists have told lawmakers at previous hearings that pharmacy-benefits companies sometimes pay less for generic drugs than it costs pharmacies to acquire them, leading to financial losses every time a patient fills a prescription for a generic.

Sen. Vernie McGaha, R-Russell Springs, asked for a show of hands from pharmacists in the audience to learn which of the three pharmacy-benefits companies they think underpay on generic drugs.

Nearly everyone raised their hands for Medco Health Solutions, which is Coventry's partner, and Catalyst Rx, which is WellCare's. No one seemed to object to US Script, which is Kentucky Spirit's partner.

Rep. John Will Stacy, D-West Liberty, grilled G. William Strein, vice president for provider relations at Medco, about the sums paid to pharmacists for generic drugs. Stacy cut off Strein several times while he was attempting to answer.

"What do you consider a reasonable reimbursement?" asked Stacy, who owns an interest in at least two Eastern Kentucky drug stores according to his 2011 financial disclosure statement.

As Strein explained that his company tried not to pay less than it costs a pharmacy to buy drugs, Stacy said, "Well, then how come you're doing that then?"

Pharmacists in the audience applauded, and Stacy added, "Now let me tell you something. I've just about lost my patience."

Hospitals, doctors, dentists, mental health providers and Medicaid patients have complained to lawmakers in recent weeks that the state's switch to managed care has led to delayed payments and complicated preapproval processes that make treatment more difficult to obtain.

Monday's hearing addressed only one item, the reimbursement to pharmacists under managed care. More hearings will be scheduled soon, said Sen. Jimmy Higdon, R-Lebanon.

"Obviously, we have a big problem here and we've just scratched the surface today," said Higdon, co-chairman of the Program Review and Investigations Committee.

John Cheves: (859) 231-3266. Twitter: @BGPolitics. Blog:

Lexington Herald-Leader is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service