CMS approved California’s 1115 waiver late last month, officially allowing the state to pursue its CalAIM program to reform Medi-Cal.
Medi-Cal Rx is one of the initiatives that went live on Jan. 1, and below we feature input from several pharmacists in the state about their experience so far using the new fee-for-service delivery system for prescription drugs.
The legislative session began on Jan. 3—also featured in this newsletter is a conversation with Asm. Adrin Nazarian about his plans for the 2022 legislative session.
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State of Reform
1. Q&A: Asm. Nazarian on the 2022 session
Funding the workforce that cares for California’s growing elderly population, making insulin more affordable, and expanding plasma donation centers will be top priorities for Asm. Adrin Nazarian this year. With the 2022 session having started on Monday, the Assembly Aging & Long-Term Care Committee Chair recently spoke with State of Reform about his health policy priorities, interim work, and continued efforts to reign in prescription drug costs.
To allow patients to make quicker and more informed decisions about which medications they pay for, Nazarian is advocating for real-time pharmacy, which ensures that patients have access to price information on all of their medication options at the point of sale. Concerning health care costs, he said: “In California, we’re talking about a $380 billion expenditure on health care on an annual basis. And that’s pre-pandemic numbers. You can just imagine what the pandemic has increased our health care costs by.”
2. Pharmacists share experiences transitioning to Medi-Cal Rx
While emphasizing the overall benefit of Medi-Cal Rx for patients and providers, some pharmacists say they’ve encountered challenges with the initiative in its first days. Dr. Cathy Mac, manager of Kyoto Pharmacy in LA, told State of Reform that the change to fee-for-service is inconsistent among different health plans, with some allowing a transition period to implement the new program and others not. She also noted several website glitches.
Mac and Dr. Ken Thai, CEO of 986 Pharmacy, both say pharmacists are still being underpaid for certain medications under the new program. Thai believes this is because DHCS hasn’t yet decided which medications it wants to cover under the new program. He suggests creating a public forum where California pharmacists can provide DHCS feedback on the program as they navigate it.
3. What They’re Watching: Steve Brennan, Change Healthcare
The ethical use of health data is a high priority for Change Healthcare, according to the organization’s senior manager for state health policy, Steve Brennan. At the 2021 Southern California State of Reform Health Policy Conference in December, Brennan highlighted California’s implementation of the 2020 California Privacy Rights Act and described how other states are following California’s leadership in health data privacy. He called the state a “vanguard” in data privacy legislation.
He says a lot of health care data use today is not covered under HIPAA—and states will need to implement their own up-to-date health data privacy laws in the absence of updated federal regulations. Brennan also explained how COVID gave his organization a renewed focus on filling gaps in health data collection. “I think one of the things that really shone during the pandemic [are] the significant inequities in our country in terms of access to health care, quality care, and then of course all of the social determinants of health that impact our communities,” he said.
4. Registration for 2022 Northern California State of Reform Health Policy Conference now open!
Our 2022 Northern California State of Reform Health Policy Conference will take place in person in Sacramento on March 23rd! We will host the event’s Convening Panel meeting next Thursday to hear from our stakeholders about what topics in state health policy they want to engage with.
We will then take the Convening Panel’s input and use it to curate a timely and diverse agenda of panels for the conference. If you already know you’d like to join us in March, take advantage of the Early Bird rates and register here!
5. The status of federal price transparency requirements
On January 1, the No Surprises Act went into effect, putting in place patient protections against surprise medical bills. But that’s just one of several efforts to improve price transparency that are currently underway at the federal level. State of Reform Columnist Jim Capretta offers a status update and a detailed look at some of those other efforts including the hospital price transparency rule and new regulatory requirements on insurers.
To improve compliance with the Hospital Disclosure Rule—which requires hospitals to post certain service prices online in a readable format—the Biden administration finalized a rule change that will increase maximum penalties to nearly $2 million per year beginning in 2022. Though some requirements have been delayed, new regulatory rules will soon go into effect requiring insurers to maintain a consumer pricing tool and to “post online for public consumption their in-network prices, their out-of-network allowed charges, and their negotiated prices for prescription drugs.”