Pharmacy Programs Could Save Billions Through Changes to Benefit Management

Medicaid pharmacy programs could save billions of dollars by using different benefit management techniques, according to a Dec. 6 report by the Lewin Group.

The report found that if Medicaid pharmacy plans were “optimally managed”—meaning they functioned more like Medicare Part D plans, Medicaid managed care organizations, and commercial plans—federal and state savings could total $30 billion over the next 10 years.

Most Medicaid pharmacy programs are administered through a fee-for-service model, which accounts for 73 percent of Medicaid pharmacy expenditures, according to the report. While states often use pharmacy benefits administrators to improve FFS program efficiency, those organizations do ...