syrtis solutions Tag

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...

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Monthly Medicaid News Recap Syrtis Solutions

09 Mar FEBRUARY MEDICAID NEWS RECAP

Syrtis Solution's February 2020 Medicaid News Recap: A roundup of Medicaid news, legislation, and industry developments relating to Medicaid integrity, cost avoidance, improper payments, fraud, waste, and abuse. Minnesota's Medicaid program made up to $29 million in improper payments for duplicate accounts   StarTribune, February 25The state agency...

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Medicaid Prescription Drug Cost Managed Care Syrtis Solutions

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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Michigan Rx Carve Out Syrtis Solutions Medicaid

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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Medicaid Third Party Liability GAO CMS Syrtis Solutions ProTPL TPL OHI

20 Sep Medicaid Third Party Liability Report From GAO

Identifying third party liability continues to be a challenge under the coordination of benefits for Medicaid plans. By law, plans are payers of last resort so whenever beneficiaries have other active coverage (OHI), those third parties should pay first. Currently, Medicaid plans are required to...

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Rx Carve Out Syrtis Solutions Medicaid California

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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Medicaid Improper Payments Syrtis Solutions DHHS

29 Aug MEDICAID IMPROPER PAYMENTS IN FY 2018

DHHS has released its annual Agency Financial Report for FY 2018. The report provides an overview of improper payments in the Medicaid program, root causes for the payments, and corrective actions. In line with the agency's goal of reforming, strengthening, and modernizing the nation’s healthcare...

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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...

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