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Important Medicaid Updates



The FY 2022 Enacted Budget delays the transition of the Medicaid pharmacy benefit by two years, until April 1,2023.
Future information will be forthcoming.



Provisional Enrollment Now Available!

Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plan (SNPs) will receive their pharmacy benefits through the Medicaid FFS Pharmacy Program instead of through their Medicaid MC plan as they do now. The Pharmacy Carve-Out does not apply to members enrolled in Managed Long-Term Care plans (e.g., MLTC, PACE and MAP), the Essential Plan, or Child Health Plus (CHP). Transitioning the pharmacy benefit from MC to FFS will provide the State with full visibility into prescription drug costs, allow centralization of the benefit, leverage negotiation power, and provide a single drug formulary with standardized utilization management protocols simplifying and streamlining the drug benefit for Medicaid members.

IMPORTANT Information for Pharmacies, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Providers and Prescribers

Please refer to the October 2020 Medicaid Update article titled Attention: Pharmacies Durable Medical Equipment, Prosthetics, Orthotics, and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service. If you are one of these providers and are not enrolled in the FFS program as billing providers you must enroll in order to continue to serve Medicaid Managed Care members. Instructions for checking enrollment status, and enrollment tips can be found in this article.

Pharmacies and DMEPOS Providers if you do not enroll in FFS as a billing provider or you are only enrolled in Medicaid in a non-billing status, pharmacy claims for Medicaid Managed Care members that are submitted to the Medicaid FFS program will be denied.



For More information please visit the Pharmacy Carve Out website