MM Curator summary
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[MM Curator Summary]: Managing drug costs in Medicaid sounds good until you have to actually walk it out. The planned MCO rx-carve out in WA may be “evolving.”
Following WSHA’s and other stakeholders’ advocacy, the Washington State Health Care Authority (HCA) announced it would delay implementation of a plan to remove coverage of certain prescription drugs, including HIV antiviral drugs, oncology drugs, and Cystic Fibrosis drugs from Medicaid managed care contracts. WSHA advocated for HCA to rescind the proposed change, citing concerns about the impact on organizations’ ability to provide these specialized services to vulnerable populations. WSHA recommended HCA pursue alternatives to carving out the drugs from managed care contracts that would not have as much impact on providers. HCA is in the process of submitting its managed care contracts and capitation rates to the Centers for Medicare and Medicaid Services for review.
The change, which was scheduled to be effective January 1, 2023, would have significantly reduced payment to providers that provide these drugs under the federal 340B program. These include disproportionate share hospitals, children’s hospitals, cancer centers, federally qualified health centers, and Ryan White clinics. WSHA appreciates HCA’s attention and response to our advocacy. (Andrew Busz, AndrewB@wsha.org)