DHCS SEEKS FFS Rx BENEFIT MANAGEMENT

DHCS FFS Syrtis Solutions Prescription Drug Costs Medicaid

20 Aug DHCS SEEKS FFS Rx BENEFIT MANAGEMENT

In January, California’s newly elected Governor, Governor Gavin Newsom signed an executive order to drastically reform health care in the state. Executive Order N-01-19 introduced a number of actions and budget proposals to reduce the cost of prescription drugs and health care. One measure, in particular, transitions all pharmacy services for Medi-Cal managed care to a fee-for-service (FFS) model.

Prescription drugs are one of the primary drivers of rising health care costs. Last year the state’s individual market saw nearly a 10% increase in health care costs and reports indicated the drug manufacturers planned to increase pricing in 2019.

FFS Rx Benefit

Currently, Medi-Cal purchases drugs with the help of public and private purchasers that negotiate with manufactures individually. Under the FFS model, California would become the largest single payer of prescription drugs and the state would have increased bargaining power to negotiate prices with manufacturers.

Governor Newsom stated, “We will use our market power and our moral power to demand fairer prices for prescription drugs. And we will continue to move closer to ensuring health care for every Californian.”

RFP # 19-96125

On July 22, California’s Department of Health Care Services issued a request for proposals for managing the FFS pharmacy benefit. RFP # 19-96125 is requesting proposals for the takeover, operation, and ensuing turnover of administration of the FFS pharmacy services. Entities including commercial businesses, nonprofit organizations, state or public universities that meet the qualification requirements are eligible for submission.