State Medicaid Programs and the Changing Dynamics of Pharmacy Benefits Management

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July 09, 2015

MAXIMUS President Bruce Caswell wrote a column for the Huffington Post on the new, changing dynamics of pharmacy benefits management programs. An excerpt is below, along with a link to the full article.

“When President Obama signed the Affordable Care Act (ACA) in 2010, millions of Americans received prescription drug coverage as part of their new health insurance. While this expanded coverage provided new access to prescription drugs for many Americans, it brought with it additional pharmacy requirements for both states and the federal government. Fast-forward to five years later and those ACA requirements are putting a heavy strain on state Medicaid programs as they work to manage pharmacy benefits for an increasingly diverse beneficiary population and an increasingly expensive array of drugs.

To ensure the prescription drug needs of the newly insured are met, Medicaid Pharmacy Benefits Managers (PBMs) fill an important role between patients and the health care system, supporting everything from negotiating drug prices to processing claims. With enrollment in Medicaid and the Children's Health Insurance Program (CHIP) growing by 19 percent since 2013 -- now covering over 70 million people -- PBMs have a vast amount of new information and data to track. This influx of Medicaid and CHIP recipients, along with the rising costs of prescription drugs, means that state Medicaid programs need to evolve to address the changing landscape. They need technology solutions and business processes that help their PBM program's efficiency and accuracy, all while keeping costs down and ensuring consumers' ability to access needed medications.” To read more, click here.

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