Medical assistance services; managed care organization contracts with pharmacy benefits managers.

Board of Medical Assistance Services; state pharmacy benefits manager. Requires the Board of Medical AssistanceServices (the Board) to select, every four years, a third-party administratorto serve as the state pharmacy benefits manager used by Medicaidmanaged care organizations under the state plan for medical assistance.Under the bill, the state pharmacy benefits manager is responsiblefor all claims under the state plan. The bill requires the Board,in selecting the state pharmacy benefits manager, to establish eligibilitycriteria, develop a master contract to be used between the statepharmacy benefits manager and a Medicaid managed care organization,and establish mandatory disclosures for the applicants. The billrequires the state pharmacy benefits manager, in consultation withthe Director of Medical Assistance Services (the Director), to developa drug formulary for use when administering prescribed drug benefits on behalf of a Medicaid managed care organization under the stateplan. The bill prohibits payments for drugs that exceed the per unitprice on the formulary. The bill requires the Director to establishan appeals process by which pharmacies may appeal any disputes relatingto the maximum allowable cost set by the state pharmacy benefitsmanager. The bill requires the state pharmacy benefits manager toprovide a quarterly report to the Board containing certain information.