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2016 Session

Budget Amendments - HB30 (Conference Report)

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DMAS Analysis of Pharmacy Claims (language only)

Item 310 #8c

Item 310 #8c

Health and Human Resources
Department of Medical Assistance Services

Language

Page 276, after line 54, insert:

"K. The Director, Department of Medical Assistance Services shall analyze pharmacy claims data from the past biennium in order to assess the value of payments made to the Medicaid program's  contracted managed care plans, and the value of payments made by the contracted managed care plans to their contracted prescription benefit managers (PBMs). Additionally, the Director shall request and, if made available, analyze the value of payments made by the  Medicaid program's managed care plans' contracted PBMs to network pharmacies for the same set of pharmacy claims.  The Director shall identify and report any difference in value in payments made to the contracted PBMs, payments made to the contracted managed care plans, and if available, to network pharmacies and shall make recommendations to the Chairmen  of the House Appropriations and Senate  Finance Committees by October 1, 2016.



Explanation

(This amendment adds language requiring the Director of the Department of Medical Assistance Services (DMAS) to analyze pharmacy claims data to identify the difference in the value of payments made to contracted Medicaid managed care plans and the value of payments made by the contracted managed care plans to their contracted prescription benefit managers (PBMs). Further, the Director of DMAS is directed to request, and if available, analyze the value of the program's managed care plans contracted PBMs to network pharmacies. The Director of DMAS is directed to identify and report any payment differences and make recommendations to the Chairmen of the House Appropriations Committee and Senate Finance Committees by October 1, 2016.)