Manatt Health Senior Managing Director Anthony Fiori was quoted in an AIS Health article discussing the benefits and risks of adopting a preferred drug list (PDL) hybrid model as more states consider “carving out” Medicaid pharmacy benefits management.
While a few states have removed pharmacy benefits from their contracts with Medicaid managed care organizations, others are looking into single PDL hybrid models. States that decide to carveout these benefits are mainly focused on increasing savings and reducing the amount of formularies that providers need to deal with. But depending on each state and the way the program is structured, removing this benefit may require significant resources and prove less suitable, especially for smaller states, according to Fiori. “The benefit of the single PDL over the carveout,” Fiori said, “[is that it provides for] a comprehensive benefit package that the plan is charged to manage, and the pharmacy data is in real time. That data is powerful, and plans use that data with their clinical systems to manage their members. I have been told by countless health plans that it’s critical to their mission.”
Read the full article here.