Tag: Prescription Drugs
The Association for Community Affiliated Plans (ACAP) enlisted The Menges Group to prepare a report on the ways in which state Medicaid agencies have opted to regulate Medicaid MCO PDL content. Most states afford MCOs wide latitude in establishing their PDLs. Conversely, a few states require MCOs to use the statewide Medicaid fee-for-service PDL, and a few others have taken a middle ground regulatory position. The paper emphasizes that utilizing the lowest-cost, clinically effective medication is one of the most important avenues available to achieve Medicaid savings, and concludes that wide MCO latitude over PDL content is the most appropriate policy.
This study explores how more efficient pharmacy benefits management—apart from drug manufacturer rebates—could save Medicaid an additional $74.4 billion over the next decade. These savings opportunities are compelling as the federal government and states strive to protect benefits and prepare for the Medicaid expansion authorized by the Affordable Care Act starting in 2014.