KFF Brief Examines PBM Role in Medicaid Drug Spending and Distribution
KFF published an issue brief analyzing pharmacy benefit managers' role in Medicaid drug distribution and their potential impact on program spending. The brief responds to recent policymaker and stakeholder concerns that PBM practices may be driving increased Medicaid drug costs. The analysis comes as states and CMS scrutinize PBM contracts with managed care organizations, including spread pricing, rebate retention, and formulary management practices. The brief provides background for state Medicaid agencies and health plans evaluating PBM contract terms and transparency requirements.
State Medicaid agencies are increasingly requiring MCOs to disclose PBM pricing arrangements and limiting spread pricing, making this analysis directly relevant to contract negotiations and oversight.
Pharmacy · Managed Care · Finance
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