Arkansas DHS moves to join multi-state drug purchasing pool, increases Medicaid primary-care visits for APRN patients

The Department of Human Services told the Senate Public Health, Welfare and Labor Committee on multiple rule items that it will join a preferred drug list pool and enter value-based purchasing (VBP) contracts with manufacturers to leverage other states' buying power and increase rebates.

"We project about $2,000,000 for next state fiscal year," DHS staff said, adding that approximately $570,000 of that would be savings to the state general fund. DHS said the change should not restrict which drugs the state can procure: "we can still, whatever drugs we choose to add to the PDL, we can still add to the PDL," a DHS presenter said.

DHS also described a separate rule implementing session legislation to let advanced practice registered nurses (APRNs) function as primary care providers in Medicaid and to increase the cap on permitted primary-care visits for fee-for-service Medicaid beneficiaries from 12 to 16 visits per state fiscal year. DHS told the committee the rule and related manual and system updates are scheduled to take effect July 1 "since those PCP visits are measured based on the state fiscal year."

On coverage for vagus nerve stimulation therapy, DHS clarified a drafting discrepancy between an exhibit summary and the rule text. When a senator noted the exhibit said a prior authorization would be "requested," DHS responded the rule itself (section 251.25) "does say that vagus nerve stimulation therapy device and procedure require prior authorization for medical necessity."

Committee members asked whether joining the multi-state purchasing pool would reduce the number of drugs Arkansas can purchase; DHS replied it "shouldn't have any restriction" on the number of drugs covered and emphasized the main effect would be improved rebates. Lawmakers also sought details about how beneficiaries with chronic conditions who need more than 16 PCP visits would be handled; DHS said an extension/authorization process exists and that staff would provide more parameters on the authorization mechanism.

The committee reviewed the rules without formal objection, and DHS agreed to make a technical wording correction in the APRN PCP rule before it moves to the next review step.

Next steps: DHS will supply the agreed technical corrections and any requested clarifications to committee staff before the rules proceed to the rules subcommittee.