For those PharmD's in Managed Care....

[Modest_anteater]

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http://gatehousenews.com/sideeffect...eaper-medicaid-drug-prices/site/dispatch.com/

Looks like states are pulling out of Medicaid and medicare Blue cross Blue shield programs and just paying their state pharmacy schools to do it for them. RIP insurance companies. WV has already done it and OHio is next.

 

[BidingMyTime]

Interesting. Illinois just started using HMO's for medicaid patients a few years ago in a bid to save money, so I can't see them going back anytime soon to their old way of doing it in-house.

 

[abrahamdrinkin]

Other states are trying to push to managed care. I don’t feel like 1 state moving away from managed care is an RIP insurance companies situation.

Also, when my state has passed this back and forth, the pharmacists just go with the contract.

 

[JustAnotherRph]

I'm not overly concerned. I do know about the OH pass-through requirement and my company is working to switch pharmacy processors to provide that to the state. More states are moving away from fee-for-service to managed care because it is cost savings. I think the problem is more to do with the medications that the Medicaid population is on. Most are on specialty medications. Specialty accounts for most of the PMPM for a plan.

I'm really not sure how well this will work considering that a patient or doctor can get what they want outside of a formulary. The doctor simply writing "tried/failed preferred medications" gets the authorization approved and negates the whole process. We don't have a system like Cleveland Clinic, Kaiser, etc for government programs that says that this drug is what you get. I mean, Medicare is the most lax formulary around with the most ridiculously lax PA guidelines.

I foresee WV going back to managed care soon. Arizona going back to fee-for-service for a bit and then went right back to managed care.