Medicaid Pharmacy Program

Announcements

The FY 2022 Enacted Budget delays the transition of the Medicaid pharmacy benefit by two years, until April 1, 2023.

This MRT II initiative will move the pharmacy benefit for 4.3 million Medicaid managed care members back to fee-for-service (FFS). Transitioning pharmacy services from Managed Care to FFS will, among other things:

  • Provide the State with full visibility into prescription drug costs.
  • Centralize and leverage negotiation power.
  • Provide a single drug formulary with standardized utilization management protocols.
  • Address the growth of the 340B program and associated reductions in State rebate revenue.

Pharmacy Carve-Out Medicaid Update Articles

  • Medicaid Pharmacy Prior Authorization Programs Update & Practitioner Dispensing(PDF) – January 2021
  • Medicaid Pharmacy Carve-Out – Special Edition:
  • Attention: Pharmacies, Durable Medical Equipment, Prosthetics, Orthotics and Supply Providers, and Prescribers That Are Not Enrolled in Medicaid Fee-For-Service (Pg. 10) – (PDF) – October 2020

Resources & Materials

  • Member Notice of Change Reversal – (Web)(PDF) Updated – 4.16.2021.
  • List of Physician Administered Drugs Added to the Medicaid List of Reimbursable Drugs – (Web)(PDF)Updated – 2.3.2021
  • 1557 Non-Discrimination and Language Services Templates – (PDF)
  • Member Notice of Change – (Web)(PDF) Updated – 4.7.2021.
  • Transition & Communications Activities Timeline – (Web)(PDF)Updated – 5.18.2021
  • Frequently Asked Questions (FAQs) – (Web)(PDF)Updated – 5.18.2021
  • Scope of Benefits – (Web)(PDF) Updated – 4.7.2021
  • Roles & Responsibilities – (Web)(PDF) Updated – 4.7.2021

Stakeholder Engagement

Presentations from All Stakeholder meetings:
Transition (Carve-Out) of the Pharmacy Benefit from Managed Care to Fee-for-Service (FFS):
Implementation Update & Strategy

Source