Ohio Managed Medicaid Pharmacy Benefit Carve-Out May Carve Back In

NASHVILLE, Tenn., July 20 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that managed care plans are already facing challenges with a new prescription drug benefit carve-out in the Ohio Medicaid program. According to the new Ohio, Kentucky & Indiana Health Plan Analysis, health plans and state officials do not yet have cost and utilization data regarding services since the carve-out was implemented on Feb. 1, 2010. However, anecdotal reports of care disruptions and other effects do not bode well for the program and will likely prompt procedural changes in the coming months.

In a carve-out, the state contracts directly with a pharmacy benefit manager for pharmacy benefit management. State Medicaid agencies generally favor carve-outs for the convenience of dealing with just one contractor. Additionally, prior to the passage of federal healthcare reform, carve-outs had an economic advantage in the greater rebates states could capture from drug manufacturers—an attractive option as state budgets tightened in recent years, particularly in hard-hit states like Ohio. However, federal health reform legislation included drug rebate equalization measures that will allow managed care organizations to access the same rebates provided through state Medicaid fee-for-service purchasing programs for prescription drugs.

"With the restoration of rebate parity between managed care and fee-for-service populations, federal reforms will likely also encourage recently carved-out Medicaid drug benefits in Ohio to carve back in," said HealthLeaders-InterStudy Analyst Rick Byrne. "Should a carve-back-in occur, managed care organizations will likely use a single formulary and a single set of utilization-management restrictions."

HealthLeaders-InterStudy Unveils New Health Plan Analysis Format

Health Plan Analysis identifies key health plan trends, allowing pharmaceutical companies to create comprehensive strategic plans and sales strategies at state and local levels. Updated quarterly and covering 35 states plus the District of Columbia, each report provides a detailed look at:

• Commercial Carriers
• Managed Medicaid Markets
• Managed Medicare Markets
• Pharmacy Benefits
• Patient Care Management
• Legislation
• Healthcare Reform

A consistent format across reports allows for market-to-market comparisons across regions on the hottest topics facing managed care.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources, Inc. at www.DecisionResourcesInc.com.

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

SOURCE HealthLeaders-InterStudy

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