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

  • Special Edition Part One: Medicaid Pharmacy Carve-Out - (PDF) - December 2020
  • 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

  • 1557 Non-Discrimination and Language Services Templates - (PDF)
  • Managed Care Plan Mailing Schedule for Member Notice of Change - (Web) - (PDF)
  • Member Notice of Change - (Web) - (PDF) Updated - 12.21.2020.
  • Transition & Communications Activities Timeline - (Web) - (PDF) - Updated - 12.14.2020
  • Frequently Asked Questions (FAQs) - (Web) - (PDF) - Updated - 1.8.2021
  • Scope of Benefits - (Web) - (PDF) Updated - 10.21.2020
  • Roles & Responsibilities - (Web) - (PDF)

Stakeholder Engagement

  • Presentation from All Stakeholder meeting held on December 21, 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 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