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Welcome to the OPEN MINDS Circle library! For over 30 years, our team has covered the news, trends, metrics, regulatory changes, and thought leaders shaping the sectors of the health and human service field that affect consumers with chronic conditions and complex support needs. This is your gateway to this $860 billion market — all the information your team needs to stay on top of the market, make strategic decisions, and manage highly effective organizations.

Executive Briefing

The Changing Medicaid Pharmacy Carve-Out Landscape

By Athena Mandros

The number of primary Medicaid behavioral health carve-outs is on the decline. In our annual analysis, we’ve seen a decrease in the number of states with behavioral health carve-outs and an increase in the number of states with integrated financing (see Do States Still Have Medicaid Behavioral Health Carve-Outs?). While the trend is toward integrated financing for physical and behavioral health services, does this apply to pharmacy benefits? Our latest report, State Medicaid Mental Health Pharmacy Carve-Outs, analyzed the market. Before diving into the findings, it’s important to level set on exactly what we mean by integrated financing versus carve-outs for pharmacy benefits. State Medicaid financing of pharmacy benefits can take one of three forms: The pharmacy benefit can be integrated with financing for...

In fiscal year (FY) 2017, Medicaid gross spending on prescription drugs was $64.0 billion, representing an increase of 5% over FY2016 spending of $60.9 billion. When drug rebates are taken into account, spending was $29.1 billion in FY2017. Drug rebates have increased each year, meaning net spending has remained essentially the same over the past three years, and even...
On October 1, 2019, the Alabama Medicaid Agency implemented the Alabama Coordinated Health Network (ACHN) to replace its Medicaid health home program and three other care coordination programs. The ACHN is a single care coordination delivery system intended to link consumers, primary care physician (PCP) groups, and community resources in each of seven newly-defined regions. In this new program,...

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