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Pharmacy Carveouts May Hurt Medicaid Managed Care Bonuses

By John Wilkerson / January 3, 2020 at 2:55 PM
When states separate drug benefits from Medicaid managed care programs, it’s more difficult for insurers to score well on performance metrics that determine plans’ bonuses and their ability to automatically enroll residents, industry sources say. Some states, including California, are removing drug benefits from managed care programs and are banning the pharmacy benefit manager practice of spread pricing. Insurers oppose so-called drug carveouts, arguing that pharmacy data is key to understanding peoples’ health and should be integrated with the other...


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