State Takeover of Medicaid Drug Plans Would Net $95 Million in Savings

Seeking to save an estimated $95 million a year, the state wants to change the way that more than 1 million low-income Pennsylvanians get their prescription drugs.

The proposal by the state Department of Public Welfare would apply to enrollees in the state’s Medicaid managed care plans, companies that are paid per capita fees to provide Medicaid recipients with medical and drug coverage. The department wants to take over the drug portion of the coverage from the plans.

Department officials, who note that other states have taken similar steps, maintain the change would enhance services for consumers and simplify requirements for medical providers.

The companies disagree, contending that the measure, known as a pharmacy “carve out,” could reduce consumer choice and undermine their efforts to manage care for enrollees with conditions like diabetes.


Question

Is it just me, or does it seem like the state and private insurers are playing tug-of-war over about $100M in drug rebates?

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