Wisconsin is joining the ranks of states who are carving out the pharmacy benefits in their Medicaid and other health programs in an attempt to maximize rebates from drug manufacturers. And though the state says it hopes to save $26 million by taking on management of the pharmacy operations, there’s some concern that the carve-out might hurt MCOs’ ability to manage patient care effectively.
Commercial plans in Wisconsin are also tightening their focus on pharmacy cost, with even more emphasis on generic utilization, and targeted use of value-based design for certain chronic illnesses. Plans are paying attention to the Wisconsin Pharmacy Quality Collaborative and its efforts to use targeted intervention and pharmacy counseling for certain patients.
Wisconsin lawmakers are still working on efforts to broaden health coverage in the state, this time focusing on a possible purchasing pool for small businesses, and on changing state law to limit risk-based underwriting of small groups.