Monday, July 19, 2021
Medicaid Monday: STAR Kids Program Beats National Benchmark
July 19, 2021
A recent external study showed that Texas’ STAR Kids program beats national benchmarks in the majority of areas. These areas include getting needed care (66% compared to 61%), positive customer experience (76% to 68%), specialist rating (82% to 74%) and access to prescription medications (75% to 69%).
STAR Kids is the Texas Medicaid managed care program serving qualified children and adults 20 and younger who have disabilities and complex medical needs. The program began service in November of 2016. A managed care model can be especially effective for children with disabilities and complex medical needs as managed care helps create coordination for a variety of routine and specialty care.
The STAR Kids program also showed exemplary performance on appointment availability studies. Reported results include:
- 100% compliance with the measures relating to members receiving urgent care within 24 hours and routine care within 14 days
- 99.9% compliance with members receiving preventive care appointments within 90 days
Wednesday, March 31, 2021
The Texas Cares RX Plan: Solving the High-Priced Insulin Crisis
March 31, 2021
By: Jamie Dudensing
Ever wonder why insulin prices are so high in the United States? It’s because our governments don’t negotiate lower prices for the drug. HB 18, the Texas Cares Rx Plan, would change this for Texas.
So far this session, the Legislature has seen a lot of discussion about insulin copay caps. However, copay cap mandates don’t actually lower the price of insulin or limit what drugmakers can charge health insurance for insulin because they don’t solve the root problem—they don’t lower the price of drugs. HB 18 would lower insulin and other prescription drug prices for the uninsured by:
- Using the buying power of the State of Texas to leverage better rates for insulin and other drugs and pass along the savings to uninsured Texans
- Creating a pharmacy benefit for uninsured Texas residents, allowing them to buy prescription drugs at post-rebate prices, plus an administration fee
- Creating a new program at HHSC to administer the program and utilize a pharmacy benefit manager to negotiate the benefits the same way they do in the private market