OPEN MINDS Announces Release Of The 2017 State Medicaid Mental Health Medication Management Policies Market Intelligence Report
Recent report provides in depth analysis on state Medicaid plan’s approaches to pharmacy benefit management
Gettysburg, Pa. (March 26, 2017) — 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. To provide readers with an in-depth analysis of Medicaid plan approaches to managing pharmacy benefits and preferred drug list (PDL) management, OPEN MINDS Market Intelligence Team released the Market Intelligence Report, State Medicaid Mental Health Medication Management Policies: The 2017 OPEN MINDS Update.
During our analysis, our team found 13 states with no managed care, seven states with a primary carve-out for mental health, five states with a primary carve-out for all pharmacy, and 34 states with a carve-in to managed care plans. Of those 34 states with a total carve-in of pharmacy benefits, eight states set the PDL and 26 states allowed each MCO to set their own PDL. Of those states with a primary carve-out for mental health pharmacy only, the most common policy (used in four states) is for states to set the PDL for mental health drugs; the PDL for all other drugs is set by the MCO. In this report, the OPEN MINDS team provides a strategic analysis of the states that exempt mental health drugs from the PDL and a state-by-state list of the organizations responsible for mental health and general pharmacy in order to understand consumer pharmacy benefits for success with integrated care.
The OPEN MINDS Market Intelligence Report, State Medicaid Mental Health Medication Management Policies: The 2017 OPEN MINDS Update, provides a detailed analysis of the 65-plus state Medicaid programs’ pharmacy benefit management. The report provides a reference guide for teams 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
“The ability to coordinate care for the whole person is now a basic premise for a wide range of new initiatives, such as health homes and accountable care organizations (ACO). This means that care teams need competencies across the complete array of services – physical health, behavioral health, pharmacy benefits, and social supports – in order to succeed with these integrated care initiatives,” said Athena Mandros, Market Intelligence Manager of OPEN MINDS. “Our team has found there is a big gap in knowledge around the management of pharmacy benefits, which is why this was the focus of our recent Market Intelligence Report. This report aims to provide care teams with the knowledge and insights needed to understand the specific management tools and PDLs for where their consumers access their medications.”
For a detailed summary of the report, check out the article, Understanding Consumer Pharmacy Benefits Is Key To Integrated Care Success, which is available at no cost to the public.
The full report is available free to OPEN MINDS Premium and Elite members in The OPEN MINDS Circle Library: State Medicaid Mental Health Medication Management Policies: The 2017 OPEN MINDS Update
The full report can also be purchased in The OPEN MINDS e-store at: https://www.openminds.com/downloads/state-medicaid-managed-care-mental-health-medication-management-policies-an-open-minds-market-intelligence-report/
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OPEN MINDS is a national strategic advisory firm specializing in the sectors of the health and human service industry serving individuals with complex support needs: mental health; addiction treatment; children and family services; intellectual and developmental disabilities; chronic disease management; long term care; social services; correctional health care; and juvenile justice.
Founded in 1987 and based in Gettysburg, Pennsylvania, the 75+ associates believe by providing the latest market intelligence and management best practices to organizations serving the health and social support needs of the most vulnerable consumers, those organizations will be better able to provide efficient and effective services. Learn more at www.openminds.com.
For additional questions and inquiries, please contact Sarah Threnhauser, Executive Vice President, OPEN MINDS at 717-334-1329 or openminds@openminds.com.