Medicaid programs willing to boot out drug pricing middlemen
Axios
— By Bob Herman, October 8, 2019
Michigan’s Medicaid program is proposing to fire the pharmacy benefit managers that handle its prescription drug claims and negotiate prices. The state would manage drug coverage itself, starting Dec. 1.
The big picture: More state Medicaid agencies have determined that outsourcing all negotiations and operations of prescription drugs to PBMs has not produced the dramatic savings they were promised.
Details: Michigan officials said in a bulletin the state could extract bigger rebates from pharmaceutical companies and cut administrative costs if the state handled all Medicaid medication benefits, instead of the current private contractors.
- Michigan would use Magellan as its sole drug claims processor.
- A spokesperson for the Michigan Department of Health and Human Services said the proposal would save $40 million, and officials “will be reviewing the feedback carefully to determine next steps.”
- CVS Health, OptumRx, MedImpact and a handful of other PBMs stand to lose business.
Between the lines: State governments, along with pharmacists, continue to lead the crusades against PBMs.
- A recently signed California regulation will shift all Medicaid drug benefits away from PBMs by 2021, and West Virginia’s Medicaid department fired its PBMs in 2017.
Recent Posts
-
Senior Care Pharmacy Coalition Opposes CMS Final Rule on Minimum Staffing Standards for LTC Facilities
The Senior Care Pharmacy Coalition (SCPC), the leading national voice for the long-term care pharmacy sector, released a statement today regarding its opposition to the Centers for Medicare & Medicaid Services (CMS) final rule on minimum staffing standards for long-term care (LTC) facilities.
-
Senior Care Pharmacy Coalition Shares Comments with CMS Regarding Medicare Part D Restructuring Guidance: “Smoothing Provisions”
SCPC filed comments with CMS in response to their guidance on the implementation of the Medicare Part D restructuring portion of the Inflation Reduction Act (IRA).
-
Drug pricing efforts threaten ‘very existence’ of LTC pharmacies: reps
President Biden in his State of the Union address last week vowed to end “Big Pharma’s” grip on prescription drug pricing and cut costs for seniors and taxpayers by another $200 million.
But the president’s plans to expand his administration’s first-ever Medicare drug price negotiations could spell big trouble for the pharmacists who support seniors living in long-term care settings, advocates warned in response.
Stay in the Know
Get the latest news and updates on issues impacting the long-term pharmacy community.