What Your Medicaid Pharmacy Administrator is Working On

We spent a couple lovely days with the Western Medicaid Pharmacy Administrators Association members in Tucson, Arizona. The following is a summary of key focus areas for many of the member states:

• Pharmacists enrolling as providers – Many states are grappling with enrolling pharmacists as Medicaid providers. Some states are experiencing low enrollment volume, which is making it hard to justify permitting the enrollment. Others have higher enrollment rates, likely due to broader abilities to prescribe. For instance, in Idaho pharmacists have authority to provide a wide range of services – including medications for common ailments such as the flu, urinary tract infections, and smoking cessation.
• Adding anti-obesity medications to the pharmacy benefit – Many programs are in various stages of adding anti-obesity medications to the pharmacy benefit. For instance, Hawaii anticipates this will be in a future State Plan Amendment, but not until fallout from the fires is resolved. Massachusetts anticipates that the regulation that adds these medications to the benefit will go into effect on or about January 1, 2024. In Michigan, many anti-obesity medications are already covered.
• Value-based contracting is hot – Many programs discussed the status of their value-based contracts, which aim to reward providers based on achievement of quality goals and, hopefully, cost savings to the program.
• Dealing with 340B drugs – The states are in various stages of grappling with the 340B Drug Pricing Program. Some are requesting survey information from 340B covered entities. Others are implementing specific modifiers for use in billing. For instance, Arkansas added mandatory medical modifiers that, reportedly, many covered entities are getting wrong, as discovered via focused audits.

• Adding diabetic supplies to the pharmacy benefit – Several programs are in the process of moving various diabetic supplies to the pharmacy benefit, including Arkansas and Florida.
• Redeterminations post-pandemic – The states are in various stages of completing redeterminations for the Medicaid patient population.

For those familiar with this Association, the big news of the conference was the announcement that the Western Medicaid Pharmacy Administrators Association and the Eastern Medicaid Pharmacy Administrators Association are combining. We appreciate the warm welcome by the Medicaid Pharmacy Administrators and look forward to seeing them all again!

Should you have questions about your Medicaid Pharmacy Administrator, the Medicaid pharmacy benefit, or any other aspects of the Medicaid programs, please contact your Quarles & Brady LLP attorney or:

• Roger Morris: (602) 229-5269 / roger.morris@quarles.com
• Elizabeth Gebarski: (414) 277-5303 / elizabeth.gebarski@quarles.com