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Miami Hospital Joins Florida's Disease Management Program

Donna Young

Jackson Memorial Hospital in Miami is the first of up to 10 hospitals to join Florida’s new Medicaid disease management program.

Pfizer Inc. is funding the program under a two-year deal it struck with Florida last June in exchange for having 23 of the company’s drugs included on the state’s Medicaid restricted-drug formulary.

Last July, Florida enacted a law that created the restricted formulary. Under that law, the state’s Medicaid Pharmaceutical and Therapeutics Committee does not consider brand-name drugs for the formulary unless manufacturers pay a supplemental rebate of 10% in addition to the 15% rebate required under federal law.

As an alternative to paying cash for the supplemental rebate, drug companies are allowed to fund and provide programs, such as the disease management program, that are expected to offset Medicaid expenditures.

Florida’s Agency for Health Care Administration is overseeing the disease management program.

Abbe Bendell, Jackson’s director of clinical resource management, said the hospital’s contract is with the state, although the funding for the program is provided by Pfizer.

To staff the program, Bendell said, the hospital is hiring 20 care managers—dietitians, respiratory therapists, and registered nurses.

Jackson does not plan to hire pharmacists to fill the care manager positions, Bendell said, because of the pharmacist shortage and the expense.

"To put it bluntly," she said, "the cost of a pharmacist’s salary is too high" for the program’s budget.

The care managers will work one-on-one with Medicaid patients who have asthma, diabetes mellitus, hypertension, or heart failure to manage their medication use.

Jackson’s care managers will use a software system developed by Pfizer to track patient information, including medical history, symptoms, clinical and laboratory data, and treatment status. The software system is being provided to the hospital under Pfizer’s contract with the state.

Bendell said the care managers are responsible for ensuring that Medicaid patients attend the disease management education classes held in various locations in the community.

Pfizer’s contract with Florida includes funding a health literacy program in addition to donating products for community health centers.

The state has contracted with the University of South Florida College of Public Health in Tampa to evaluate the health literacy program’s effectiveness.

Pfizer has guaranteed that the combined programs will save the state $33 million in Medicaid expenses over two years.

Florida law prohibits the public from knowing the amount of Pfizer’s contract with the state.

Bendell declined to state the amount of her hospital’s contract with the state.

David Medvedeff, program administrator for the Pharmaceutical Care Network Services Corp., a networking organization established by the Florida Pharmacy Association, said the state did not provide enough funding to include pharmacists in the disease management program.

Medvedeff’s organization is seeking support from Florida legislators to appropriate funds for the purpose of involving pharmacists in the management of Medicaid beneficiaries’ drug regimens.

He said the issue has been scheduled five times on the agenda of Florida’s Joint Legislative Budget Commission. But, he said, issues pertaining to Florida’s $1.7 billion budget shortfall, announced soon after the September 11th terrorist attacks, took precedence over the pharmacist issue.

"It was canceled each time," he said. "But we are still alive and kicking."

He said his organization hopes to have the pharmacist issue back on the agenda when the legislature meets for its regular session beginning this month.

Pharmaceutical Care Network Services, Medvedeff said, is not trying to replace the contract the state has with Consultec Inc. of Atlanta (now part of ACS State Healthcare of Dallas), the company hired by Florida to oversee its restricted-drug formulary program.

A Consultec pharmacist must approve the prescriptions for Medicaid beneficiaries before payment is made.

"It is much more rational to have a Florida pharmacist that can interact face-to-face with the patients and work with the Florida physician rather than someone who is in another state making decisions," Medvedeff said. "We are not wanting to second guess what the Consultec people are doing. We look at it as more of an enhancement and that we are taking it to the next level. And we think that it will ultimately save the state more money."

Medvedeff said that the Florida Medical Association opposes pharmacists’ participation in the disease management program.

"And there isn’t even any Medicaid provider on their board," he said.

The American Society of Health-System Pharmacists sent a letter to Florida’s House Appropriations Committee last October in support of Pharmaceutical Care Network’s proposal to include pharmacists in the management of Medicaid beneficiaries’ drug therapies. The Florida Society of Health-System Pharmacists is also supporting the effort.