Pennsylvania To Gain Control Of Medicaid Managed Care Plan

Theadministration of Pennsylvania Gov. Ed Rendell (D) has proposed shiftingcontrol of the prescription drug component of Medicaid managed care plans tothe state Department of Public Welfare, the Pittsburgh Post-Gazette reports. According to department officials, thechange would enhance services, simplify requirements for medical providers andsave the state an estimated $95 million annually.

The state already administers pharmacy benefits for about 800,000 otherMedicaid beneficiaries. State Medicaid agencies can negotiate larger rebatesfrom drug manufacturers than managed care plans. The rebates would make up thebulk of the estimated $95 million in savings. Under the proposal, the managedcare plans would have "real-time" access to the state's pharmacyclaims data and could use the data to ensure patients receive the mostappropriate medications for their conditions, Mike Nardone, the department'sdeputy secretary for medical assistance programs, said.

Estelle Richman, secretary of the agency, said the program would be simplifiedby establishing a single statewide list of preferred drugs and a list ofprocedures to submit claims and request prior authorization of certainmedications. The formularies would not be as restrictive as those used bymanaged care plans, she said.

Managed care officials oppose the idea, saying that shifting oversight of thebenefits to the welfare department would reduce options for beneficiaries(Fahy, Pittsburgh Post-Gazette, 5/21).

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