The Massachusetts Health Policy Commission released a new report evaluating potential reforms to MassHealth’s managed care pharmacy benefit. The analysis by Marsh Government Health Consulting estimates that moving pharmacy benefits from managed care to the state’s fee-for-service program could generate between $151.7 million and $193 million in annual savings. Additionally, the study found that moving to a single PBM model is estimated to generate between $10.1 million and $34.9 million annually.
For community pharmacies, the report finds that both approaches would likely increase reimbursement, potentially helping prevent pharmacy closures without materially increasing MassHealth’s pharmacy spending. A fee-for-service carve-out would also expand the number of pharmacies available to managed care members through MassHealth’s “any willing pharmacy” network. The findings will inform ongoing state discussions about MassHealth pharmacy benefit reform.
Read the full report here.
