To reign in prescription drug costs and increase Medicaid program transparency, New York’s Governor, Kathy Hochul, and the New York Medicaid Redesign Team announced earlier this year that the state would carve-out the prescription drug benefit from the Medicaid program. After being delayed for two...
In March 2020, under former Governor Andrew Cuomo’s administration, the New York Medicaid Redesign Team recommended that the state carve-out pharmacy benefits from the Medicaid program due to concerns regarding pharmacy spend and provider transparency. The reform essentially transitions prescription drug reimbursement from a managed care model to...
Wisconsin Pharmacy Carve-Out Last year, the Wisconsin Department of Health Services carved out prescription drugs from the Family Care Partnership Program and transitioned to a Fee-for-Service (FFS) delivery model. The carve-out ensured compliance with the 2020 Medicaid and CHIP Managed Care Final Rule and eliminated the...
In addition to the pandemic driven economic downturn and the consequential surge in Medicaid enrollment, rising prescription drug costs in the Medicaid program have caused tremendous fiscal pressure on state budgets over the years. In 2017, pharmaceuticals accounted for 5.1 percent of Medicaid benefit spending, and this expense...