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    Medicaid Expansions Mean New Roles for Pharmacists

    Pharmacists will be the most frequent point of contact for new Medicaid patients.

     

    Amy Shin, CEO of the Health Plan of San Joaquin, said the two counties her health plan covers in California saw tremendous growth after the expansion.

    “Both at the federal and the state level, they completely underestimated the number of people who qualify,” she said, adding that many estimates were inaccurate because there was limited data to guide projections.

    The Health Plan of San Joaquin serves only Medicaid patients, with about 350,000 members in San Joaquin and Stanislaus counties in California. The plan tries to have a telephone wait time of less than 30 seconds for its members, but after the expansion, wait time initially shot up to 30 minutes, Shin said.

    Additional coverage in Louisiana“That was the kind of experience almost every health-care industry organization had because of the expansion,” she said. This increase in volume was also probably felt at the pharmacy level as more patients gained access to pharmacy benefits, she added.

    Expansion’s Impacts

    Medicaid patients have different and unique sets of needs as a population. Before the expansion, many in the industry divided Medicaid patients into two groups: Temporary Assistance for Needy Families (TANF) or Aged, Blind, and Disabled (ABD).

    TANF Medicaid patients are younger families who typically use less pharmacy prescriptions and medical services than the ABD group (called Seniors and Persons with Disabilities in California). The ABD group typically includes older adults with more complex health-care needs.

    Expansion, Shin said, introduced a third group. Health plans have learned that this expansion group falls somewhere in the middle, with higher prescription drug utilization than the TANF group.

    Ken Perez, Vice President of Healthcare Policy at Omnicell, said data already shows hospital utilization increased since implementation of health-care reform, in part due to Medicaid expansion. But while use has increased, one of the challenges is that patients aren’t always seeking the most appropriate levels of care, often turning to emergency rooms for care that could be more appropriately and more cost effectively provided at alternate sites of care, he said.

    Related article: How is the ACA like Grandpa’s WC?

    For pharmacists, increased hospital use means an increase in the drug volume used at hospitals. Inpatient drug spending has seen tremendous growth. Perez pointed to the results of a recent survey of 712 hospitals done by NORC at the University of Chicago that found that, between fiscal years 2013 and 2015, inpatient drug spending at U.S. community hospitals increased 23.4%. The average inpatient drug spending grew 38.7% during that period.

    “The Medicaid expansion, because of the nature of the Medicaid population socioeconomically and in terms of behavior and the growth in use of drugs, is now highlighting the importance of pharmacy and medication as a percentage of a portion of costs,” Perez said. 

    Jill Sederstrom
    Jill Sederstrom is a Contributing Editor

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