Medicaid Pharmacy Program

Announcements

Pharmacy Benefit Transition: The FY 2022 Enacted Budget delays the transition of the Medicaid pharmacy benefit by two years, until April 1, 2023.

Information about the Medication Assisted Treatment (MAT) formulary has been moved to the Medicaid Pharmacy Program website.

Pharmacy Benefit Transition:

This MRT II initiative will move the pharmacy benefit for over 5 million Medicaid managed care members back to fee-for-service (FFS). Transitioning pharmacy services from Managed Care to FFS will, among other things:

  • Provide the State with full visibility into prescription drug costs.
  • Centralize and leverage negotiation power.
  • Provide a single drug formulary with standardized utilization management protocols.
  • Address the growth of the 340B program and associated reductions in State rebate revenue.
  • Pharmacy Benefit Transition
    • Medicaid Pharmacy Prior Authorization Programs Update & Practitioner Dispensing - (PDF) - January 2021
    • Medicaid Pharmacy Benefit Transition - Special Edition:
    • Attention: Pharmacies, Durable Medical Equipment, Prosthetics, Orthotics and Supply Providers, and Prescribers That Are Not Enrolled in Medicaid Fee-For-Service (Pg. 10) - (PDF) - October 2020

Pharmacy Benefit Transition

  • 1557 Non-Discrimination and Language Services Templates - (PDF)
  • Transition & Communications Activities Timeline - (Web) - (PDF) - Updated - 5.18.2021
  • Frequently Asked Questions (FAQs) - (Web) - (PDF) - Updated - 5.18.2021
  • Scope of Benefits - (Web) - (PDF) Updated - 4.7.2021
  • Roles & Responsibilities - (Web) - (PDF) Updated - 6.27.2022
Presentations from All Stakeholder meetings:
Transition of the Pharmacy Benefit from Managed Care to Fee-for-Service (FFS):
Implementation Update & Strategy
340B Advisory Group Meetings
  • Meeting 1 - August 5, 2020 (updated) (PDF)
  • Meeting 2 - August 26, 2020 (PDF)
  • Meeting 3 - September 16, 2020 (PDF)