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...
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...