Single Drug Formulary Announced for Medicaid Managed Care Plans

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Single Drug Formulary Announced for Medicaid Managed Care Plans

Friday, February 20, 2015

The Michigan Department of Community Health (MDCH) recently announced changes in the upcoming request for proposal (RFP) for the Medicaid Managed Care Health Plans. 

Starting with the new contracts, effective January 1, 2016, pharmacy services that have been covered by the Medicaid Health Plans will be carved out. Currently, each Medicaid Health Plan has their own formulary for covering drugs. All pharmaceutical services for Michigan Medicaid beneficiaries will no longer be the responsibility of the Medicaid Health Plans and will be through a single contracted pharmacy entity. This change will result in cost savings through increased pharmaceutical rebates and administrative efficiencies at the state level; and, will also result in significantly streamlined administration for providers. 

The health plans have organized around a campaign to question the need for a single drug formulary. The Michigan State Medical Society (MSMS) needs your help. In order for MSMS to act on your behalf, we are in need of practices that will share their experiences with costs, time and administrative hassle it takes to have multiple formularies for your Medicaid patients

Multiple formularies have been a challenge for physicians, hospitals and patients. The complexity of multiple coverage arrangements takes time. It is yet another administrative hassle that practices absorb while accepting 60 cents on the dollar for participating in Medicaid. If Medicaid cannot pay the costs of caring for a patient, why can't it eliminate as many hassles as possible for the provider.

As an MSMS member, we are advocating on your behalf. Please watch your inbox for additional engagement on this issue.