A Review and Analysis of the Medicaid Prudent Pharmaceutical Purchasing Bill and Its Impact on Managed Care Pharmacy

Abstract

The Medicaid Prudent Pharmaceutical Purchasing Bill is designed to improve Medicaid patients' access to medications in return for signed rebate agreements from pharmaceutical manufacturers. The legislation also recognizes and attempts to develop the potential clinical role of pharmacy through mandates for drug utilization review, patient counseling, and electronic claims processing for Medicaid patients. Managed care pharmacy has a distinct advantage in the achievement of these clinical roles; it has already implemented drug utilization review and has electronic claims capabilities. This article reviews the legislation and describes the potential impact of the law on managed care pharmacy practice. The government is a major player in terms of setting health policy and trends in this country, and managed care pharmacy departments should be keenly aware of the legislative impact on overall future pharmacy trends. The potential exists for other government agencies and eventually the private sector to require and reimburse for provisions similar to those described in the Medicaid legislation. Managed care pharmacists should take a special interest in ensuring that the demonstration projects and studies mandated by the legislation show positive documentation of pharmacists' intervention so that eventually pharmacists will be properly compensated for such services in the public and private sectors.