Pharmacy Carve Out

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

Resources & Materials

Stakeholder Engagement

  • Presentation from All Stakeholder meeting held on November 16, 2020: Transition (Carve-Out) of the Pharmacy Benefit from Managed Care to Fee-for-Service (FFS): Implementation Update & Strategy - (Web) - (PDF)
  • Presentation from All Stakeholder meeting held on October 19, 2020: Transition (Carve-Out) of the Pharmacy Benefit from Managed Care to Fee-for-Service (FFS): Implementation Update & Strategy - (Web) (PDF) (Updated)
  • Presentation from All Stakeholder meeting held on September 21, 2020: Transition (Carve-Out) of the Pharmacy Benefit from Managed Care to Fee-for-Service (FFS): Implementation Update & Strategy - (Web) - (PDF) (Updated)
  • Presentation from All Stakeholder meeting held on August 17, 2020: Transition (Carve-Out) of the Pharmacy Benefit from Managed Care to Fee-for-Service (FFS): Implementation Update & Strategy - (Web) - (PDF)
  • Presentation from All Stakeholder meeting held on July 13, 2020: Transition (Carve-Out) of the Pharmacy Benefit from Managed Care to Fee-for-Service (FFS): Implementation Update & Strategy - (Web) - (PDF)
  • 340B Advisory Group Meetings