Below is an excerpt from the article, "California Carving Out Pharmacy Benefits and Going FFS". You can read the full article on the Managed Healthcare Executive website.
Pros and cons
Christine M. Tomcala, CEO of Santa Clara Family Health Plan, San Jose, California, says the company's main goal is to ensure timely access to high-quality care for its Medi-Cal beneficiaries and with the pharmacy benefit no longer being managed by the health plan, there will be transitional challenges, such as beneficiaries needing to move to different drugs covered by the new state formulary and reduced ability for the plan to assist beneficiaries in obtaining medically necessary drugs.
Therefore, the health plan feels this plan carries both upside and downside risk.
"On the one hand, this may be an opportunity to get some measure of control over runaway drug costs, which are consuming an ever-increasing share of healthcare spending," Tomcala says. "On the other hand, we are concerned about the effects of further fragmenting the provision of services, and how it will affect our ability to care for our members."