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
-
Pharmacy Community Stands Together to Protect Seniors and Prevent a Long-Term Care Crisis
The Senior Care Pharmacy Coalition (SCPC), representing the nation’s long-term care pharmacies, the American Society of Consultant Pharmacists (ASCP), representing pharmacists and pharmacies dedicated to managing medications for older adults and medically complex patients, and the National Community Pharmacists Association (NCPA), representing community pharmacists nationwide, stand united in support of immediate action—whether through legislation or […]
-
Rep. Beth Van Duyne: Congress can save seniors’ access to medications before it’s too late
Seniors in nursing homes across the country depend on round-the-clock care and medications, perhaps more than any other American patient population. In turn, the nursing homes and assisted living facilities that care for them depend on a small number of specialized long-term care (LTC) pharmacies to ensure their patients have access to the prescription meds they need.
-
Bill Aims to Offset Reimbursement Losses for Long-Term Care Pharmacies Catering to Nursing Homes
Starting in January, falling prices for costly drugs may strain long-term care pharmacies, but proposed legislation backed by advocacy groups aims to subsidize some of this loss. And nursing home advocacy groups are among those urging Congress to pass the Preserving Patient Access to Long-Term Care Pharmacies Act.
Stay in the Know
Get the latest news and updates on issues impacting the long-term pharmacy community.