FFS Tag

MEDICAID PHARMACY CARVE-OUT SYRTIS SOLUTIONS PROTPL

29 Jul MEDICAID PHARMACY CARVE-OUTS

    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...

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prescription drug costs pharmacy benefits carve out medicaid syrtis solutions

25 Aug PRESCRIPTION DRUG COSTS LEAD TO CARVE-OUT IN OHIO

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...

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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...

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27 Jan MEDICAID MANAGED CARE Rx BENEFITS HELP STATES

Medicaid prescription drug spending has been on the rise and some states have opted to carve out prescription drug benefits and transition to a Fee-For-Service (FFS) model. In theory, this delivery system helps states assert their purchasing power to reduce costs and improve oversight. However,...

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25 Nov MICHIGAN MEDICAID PBM RX CARVE OUT

To reduce costs in its Medicaid Health Plan (MHP), Michigan is carving out pharmacy benefit managers (PBMs) and transitioning to a fee for service (FFS) model for the delivery of prescription drugs. In October, Michigan’s Department of Health and Human Services (MDHHS) announced that outpatient...

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11 Sep CONCERNS OVER CA’s Rx CARVE OUT

California’s Governor, Gavin Newsom, signed an executive order at the beginning of the year to move all pharmacy services for Medi-Cal from managed care to a FFS model. The consolidated purchasing power would leverage the state’s population size to negotiate drug prices with pharmaceutical...

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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...

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