To the Editor.—We read with cautious
optimism the article by Dr Epstein1 on Medicaid
managed care and quality of care. As physicians in the Community Health Network
(the safety net delivery system of San Francisco, Calif), we have witnessed
some of the positive and negative effects of the evolution in health care
that he described. We have numerous practical concerns about quality of care
that are not being addressed by the state. For example, with regard to pharmacy
benefits, the state has avoided taking a stance on the policy of health plans
to authorize no more than a 1-month supply of medications to enrollees. The
health plans are concerned with the negative fiscal impact dispensing medications
to ineligible patients would have on their bottom line (15% of patients in
San Francisco either change plans or become ineligible on a monthly basis).
The plans would rather pay the monthly pharmacy dispensing fee ($2.25) 3 times,
than dispense a 3-month supply of medications at 1 time, since months 2 and
3 are potential losses.
Schillinger D, Ofman D. Medication Dispensing and Medicaid Managed Care. JAMA. 1998;279(12):912-913. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-12-jbk0325