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To get drugs listed on the formulary, manufacturers are usually required to pay the PBM a manufacturer's rebate, which lowers the net price of the drug, while keeping the list price the same. [20] The complex pricing structure of the formulary can have unexpected consequences.
The concern behind the measure, House Bill 408, is that some substance-abuse recovery facilities have recruited clients from Tennessee and other states to come to Kentucky and enroll in Medicaid ...
The states are Alaska, Georgia, Hawaii, Kentucky, Michigan, Minnesota, Montana, Nevada, New Hampshire, Rhode Island, New York and Tennessee as well as the District of Columbia. Top Dollar Program (TOP$)SM is the State Medicaid Pharmaceutical Purchasing Pool started by Provider Synergies, for Louisiana and Maryland in 2005. Delaware, Idaho ...
The Medicaid drug rebate for brand name drugs, paid by drug manufacturers to the states, is increased to 23.1% (except for the rebate for clotting factors and drugs approved exclusively for pediatric use, which increases to 17.1%), and the rebate is extended to Medicaid managed care plans; the Medicaid rebate for non-innovator, multiple source ...
Second, independent pharmacies are disadvantaged when health plan sponsors (employers, et al.) decide to require, or financially incentivize, patients to use mail order pharmacies. Third, many independent pharmacies are challenged by the growth of “preferred pharmacy” health plan designs that greatly restrict the patients’ choice of pharmacy.
Even for doctors trained in addiction medicine — motivated to treat opioid addicts with buprenorphine and able to work within Medicaid’s numerical limits — there are still roadblocks. Kentucky’s Medicaid program, like those of many other states, requires prior authorization before it agrees to pay for the medication.
Medicaid beneficiaries in North Carolina will soon be able to get GLP-1 drugs like Wegovy, Saxenda and Zepbound covered. NC Medicaid to cover weight-loss drugs like Wegovy, after access cut for ...
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