MEDICAID-MCO RX PAYMENTS

This bill establishes a minimum reimbursement standard for pharmacies that are not classified as critical access care facilities, requiring Medicaid managed care organizations to pay at least the same rates as the traditional fee-for-service program. The law mandates that these payments cover both the professional dispensing fee and the acquisition cost of the medication, regardless of whether the managed care organization pays the pharmacy directly or uses a third-party pharmacy benefit manager. Additionally, the bill directs the state Department of Healthcare Finance to implement various cost-control measures, such as limiting the number of prescriptions for certain drugs within a 30-day period and requiring prior approval for specific high-cost medications.