Centene Corp.

Centene Corp. and Wellcare of Georgia Inc. plan to merge. Both companies provide Medicaid managed care in Georgia.

Georgia insurance regulators will decide next month whether or not to approve a merger of two managed care companies, WellCare of Georgia Inc. and Centene Corp.

A group of Georgia physicians and pharmacists say a merger between the two companies could monopolize insurance coverage and jeopardize patients.

The Office of Insurance and Safety Fire Commissioner held a public hearing for comment on Monday. The public will have until Sept.16 for additional input. 

A spokesperson for Insurance Commissioner John F. King said Tuesday that he and his staff are still reviewing all of the relevant information surrounding the merger.

“Given the important role he plays in the outcome of this matter, Commissioner King is not in a position to comment at this time,” said Weston Burleson, director of communications and legislative affairs.

The state will have 30 days after the deadline for public input to decide on the merger.

The Medical Association of Georgia, Georgia Pharmacy Association and the Georgia Society of Clinical Oncology sent a letter to King opposing the merger last week. 

The merger would create the largest Medicaid managed care company in the country, according to the group.

“As to the Georgia Medicaid managed care market specifically, out of approximately 1,342,432 lives in the managed care program, 814,729 lives would fall under the Centene umbrella between WellCare and Peach State which is a subsidiary of Centene,” the letter said.

The Office of Insurance oversees and regulates insurance companies. According to Georgia law, the acquisition should not be approved if it “lessens competition.”

The opposing group says the merger would allow Centene and WellCare to capture 61 percent of the state’s Medicaid managed care market.

The group also argues that Centene has an ownership stake in two pharmacy benefit managers used by Georgia, Envolve Pharmacy Solutions and Rx Advance.

The letter points to a 2018 appropriations report that shows Georgia spent $120 million on pharmacy benefits, but only $90 million was used for drug reimbursement. The remainder was kept by the pharmacy benefit managers.

“At a time when pharmacists and other prescription drug dispensers, such as oncologists, are struggling to keep their doors open throughout our state as a result of low Medicaid managed care reimbursement, Georgians and the state can ill afford such waste,” the letter states.

Overall, the group alleges that Centene’s history reflects its self-interest and a lack of priority for patients.

They believe that Centene has set a standard for prior authorizations and rebate incentives for prescriptions over physician and pharmacist guidance “meaning fewer Georgia dollars being spent on Georgia patients and paid to Georgia healthcare providers which results in barriers to care between providers and patients,” said the letter.

The group had originally asked the commissioner to postpone the decision until December. However, the office said the commission should have a decision by mid-October.

“Once a final decision has been made, we will be sure to make it available to the public by posting it to our website,” Burleson said.

Staff Reporter

Nyamekye Daniel has been a journalist for three years. She was the managing editor for the South Florida Media Network and a staff writer for The Miami Times. Daniel's work has also appeared in the Sun-Sentinel, Miami Herald and The New York Times.