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States, Federal Government Could Save $30 Billion by Managing Medicaid Pharmacy More Like Medicare and Commercial Sector Programs
Date:12/6/2010

WASHINGTON, Dec. 6, 2010 /PRNewswire-USNewswire/ -- A new study from The Lewin Group finds that Medicaid pharmacy could save more than $30 billion over the next decade by transitioning from the current approach used by state Medicaid fee-for-service (FFS) programs to the more efficient approaches used by Medicare Part D plans, Medicaid managed care organizations (MCOs), and the commercial sector, including typical state employee plans. 

 The study notes that Medicaid FFS pharmacy programs use fewer generic drugs and pay pharmacies higher dispensing fees and ingredient costs than other programs.  The findings from this groundbreaking report challenge the assumption that Medicaid pharmacy can only reduce costs by cutting benefits, limiting eligibility, demanding deeper manufacturer rebates, or paying drugstores higher dispensing fees in exchange for more pricing transparency.

"Medicaid is one of the few pharmacy benefit programs that still relies heavily upon a fee-for-service approach.  By operating more like Medicare and commercial market plans, Medicaid could increase the use of generics and save billions without cutting benefits," said Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt. 

Currently, three-fourths of Medicaid pharmacy dollars are administered using a fee-for-service approach in which public officials play a role in determining how much to pay drugstores for each prescription filled (dispensing fees) and ingredient costs (the reimbursement for the cost of the actual drugs).   The other one-fourth of Medicaid pharmacy is managed more like pharmacy benefits in the commercial sector, where third-parties use proven utilization management tools and negotiate pharmacy payments directly with chain drugstores and the drug wholesalers that represe
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SOURCE Pharmaceutical Care Management Association
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