NASHP Catalogs State Approaches to Medicaid Pharmacy Benefit Management
NASHP has published an overview describing strategies state Medicaid agencies use to manage pharmacy benefits and oversee PBMs, including carve-outs from MCO contracts and single-PBM models. The overview cites KFF's Medicaid Budget Survey for State Fiscal Years 2025 and 2026, noting eight states, California, Missouri, New York, North Dakota, Ohio, Tennessee, Wisconsin, and West Virginia, report fully carving the outpatient prescription drug benefit out of MCO contracts. It also describes a single-PBM model in which a state contracts with one PBM across all MCOs to streamline administration and reduce costs. NASHP notes the chart reflects publicly available information as of May 2026 and that state approaches change frequently as states go through new procurement cycles.