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
- 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 - 4.7.2021
- Frequently Asked Questions (FAQs) - (Web) - (PDF) - Updated - 4.7.2021
- 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
- March 25, 2021 - (Web) - (PDF)
- February 26, 2021 - (Web) - (PDF)
- January 19, 2021: - (Web) - (PDF)
- December 21, 2020: - (PDF)
- November 16, 2020 - (Web) - (PDF)
- October 19, 2020 - (Web) (PDF) (Updated)
- September 21, 2020 - (Web) - (PDF) (Updated)
- August 17, 2020 - (Web) - (PDF)
- July 13, 2020 - (Web) - (PDF)
- 340B Advisory Group Meetings
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