Tag: Prescription Drugs
Utah’s Medicaid program contracts with four Accountable Care Organizations (ACOs) to coordinate care for most of the state’s Medicaid enrollees. This October 2024 report examines the fiscal and programmatic impacts that transitioning to a prescription drug carve-out model, where the pharmacy benefit would be managed under a single-payer system using the fee-for-service payment methodology, would have on Utah’s Medicaid program. Our key recommendations include preserving the current pharmacy carve-in model, piloting a hybrid Preferred Drug List that allows the Utah Department of Health and Human Services and the ACOs to jointly guide utilization towards the most cost-effective drugs for specified drug classes, and exploring potential revisions to supplemental rebates collection and capitation rates for the pharmacy benefit.
This report explores the fiscal and programmatic impacts that a switch to a prescription drug carve-out model, where the pharmacy benefit would be managed under a single-payer system within Medicaid using the fee-for-service payment methodology, would have on Virginia’s Medicaid program (Cardinal Care). Our key recommendations for the Medicaid program include preserving the current pharmacy carve-in, preserving the common core formulary (i.e., the preferred drug list), enhancing reimbursements to critical access pharmacies, increasing MCO policymaking representation, and exploring potential revisions to capitation rates for the pharmacy component.
This report explores which prescription drug model is best suited for Washington’s Apple Health (Medicaid) program: the current carve-in prescription drug model, under which managed care organizations (MCOs) pay for members’ prescriptions, or a carve out model, where prescriptions are managed by a separate company using a fee-for service (FFS) payment mechanism. Our overall recommendation is that Washington should preserve the carve-in pharmacy model for the Medicaid program
This report describes trends in opioid and medication-assisted treatment (MAT) prescription drug usage in Medicaid, put together for a presentation at a recent opioid conference.
Building upon our 2014 report titled Prescription Drug Adherence in Medicaid Managed Care, this report provides updated analyses performed on medication adherence, assesses the impacts of Medicaid expansion and the COVID-19 pandemic on medication adherence, and offers recommendations for further improvement to Medicaid medication access and adherence.