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Payers use a variety of strategies to regulate what medications are provided through their pharmacy benefit in order to both mitigate their costs and improve the quality of consumer health care. There are multiple approaches payers use to mitigate costs. These strategies often overlap, creating a very complex national landscape for prescription medication reimbursement policy and practices. The focus of this market intelligence report is Medicaid plan approaches to managing pharmacy benefits and PDL management.

For the 65-plus state Medicaid programs, we have analyzed each state Medicaid plan’s approaches to pharmacy benefit management. The report provides a reference guide for your team with:

  • A comprehensive list of states that utilize a carve-out for all pharmacy benefits and states that utilize a carve-out for mental health pharmacy only
  • A state-by-state list of the organizations that are responsible for mental health and general pharmacy
  • A review of states that allow the managed care organizations to set the PDL
  • A strategic analysis of the states that exempt mental health drugs from the PDL

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