MICHIGAN MOVES AWAY FROM RX CARVE-OUT

Michigan Medicaid Rx Carve Out Preferred Drug List Syrtis Solutions

11 Mar MICHIGAN MOVES AWAY FROM RX CARVE-OUT

From Carve-Out to Single PDL

Back in September, Michigan proposed policy 1936-Pharmacy to carve-out the State’s Managed Medicaid outpatient pharmacy drug coverage and transition to a Fee-for-Service (FFS) model. However, plans to carve-out pharmacy benefits have recently been updated. After considering the policy, the State has decided to instead implement a single Medicaid Preferred Drug List (PDL). The single PDL was a recommendation in the Governor’s Executive Budget and works to maximize manufacturer rebates in order to increase savings. In addition to the PDL, MDHHS is also recommending raising MHP’s dispensing fee to $3 for independent pharmacies. Currently, the department is drafting an updated policy and there will be an opportunity for public comment.