Services Provided by Pharmacy Vendors or PBMs in Medicaid Fee-for-Service Benefit

As of July 1, 2019

Location	Claims Payment	Utilization Management	Drug Utilization Review (DUR)	Preferred Drug List Management	Rebate Reporting Processes/Dispute Resolution	Network Contracting or Credentialing	Fraud, Waste, and Abuse	P&T Committee/DUR Board Support	Other
United States	Yes: 44, No: 6, NR: 1	Yes: 42, No: 8, NR: 1	Yes: 36, No: 14, NR: 1	Yes: 35, No: 15, NR: 1	Yes: 36, No: 14, NR: 1	Yes: 14, No: 36, NR: 1	Yes: 15, No: 35, NR: 1	Yes: 35, No: 15, NR: 1
Alabama	Yes	Yes	Yes	No	No	No	No	No	Academic Detailing
Alaska	Yes	No	No	No	No	No	No	No
Arizona	Yes	Yes	Yes	No	No	Yes	Yes	No
Arkansas	Yes	Yes	Yes	Yes	Yes	No	No	Yes	Point of sale claims processing and help desk call center
California	No	No	No	No	No	No	No	No
Colorado	Yes	Yes	No	Yes	Yes	No	No	Yes
Connecticut	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes
Delaware	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes
District of Columbia	Yes	Yes	No	Yes	Yes	Yes	Yes	Yes
Florida	No	Yes	Yes	Yes	Yes	No	No	Yes
Georgia	Yes	Yes	Yes	Yes	No	No	Yes	Yes
Hawaii	Yes	Yes	No	No	Yes	No	No	No
Idaho	Yes	Yes	Yes	Yes	Yes	No	No	Yes
Illinois	Yes	Yes	Yes	No	Yes	No	No	No
Indiana	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Rate setting
Iowa	Yes	Yes	Yes	Yes	Yes	No	No	Yes	Claims Processing
Kansas	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Kentucky	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes
Louisiana	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes
Maine	No	Yes	Yes	Yes	No	No	No	Yes
Maryland	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	Claims processing
Massachusetts	Yes	No	No	No	Yes	Yes	No	No
Michigan	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes	MAC pricing, supplemental rebate opportunities, discount savings program
Minnesota	No	Yes	Yes	Yes	No	No	No	Yes
Mississippi	Yes	Yes	No	No	Yes	No	Yes	No
Missouri	Yes	Yes	Yes	Yes	No	No	No	Yes
Montana	Yes	Yes	Yes	Yes	No	No	No	Yes	AAC Pricing
Nebraska	Yes	Yes	Yes	Yes	No	No	Yes	Yes
Nevada	Yes	Yes	Yes	Yes	Yes	No	No	Yes
New Hampshire	Yes	Yes	Yes	Yes	Yes	No	No	Yes
New Jersey	Yes	Yes	Yes	No	No	Yes	No	No
New Mexico	Yes	No	No	No	Yes	Yes	No	No
New York	Yes	Yes	Yes	Yes	Yes	No	No	Yes	Automated Prior Authorization
North Carolina	Yes	No	No	No	No	No	No	No
North Dakota	Yes	Yes	No	Yes	Yes	No	Yes	No
Ohio	Yes	Yes	Yes	Yes	Yes	No	No	Yes	Help Desk Support, Claims Review, Coordinated Services Program
Oklahoma	Yes	Yes	Yes	Yes	No	No	No	Yes	Pharmacy Helpdesk
Oregon	Yes	Yes	No	No	Yes	No	No	No
Pennsylvania	Yes	No	No	No	Yes	No	No	Yes
Rhode Island	No	Yes	Yes	Yes	Yes	No	Yes	Yes
South Carolina	Yes	Yes	Yes	Yes	Yes	No	Yes	Yes
South Dakota	Yes	No	No	No	Yes	No	No	No	Pharmacy Helpdesk
Tennessee	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Coordination of TPL and Supplemental Rebate Contract Negotiation
Texas	No	Yes	Yes	Yes	Yes	Yes	No	Yes	Claims processing
Utah	NR	NR	NR	NR	NR	NR	NR	NR
Vermont	Yes	Yes	Yes	Yes	Yes	No	No	Yes	Provider Call Center
Virginia	Yes	Yes	Yes	Yes	Yes	No	No	Yes
Washington	Yes	No	No	No	No	No	No	No
West Virginia	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes
Wisconsin	Yes	Yes	Yes	Yes	Yes	No	No	Yes
Wyoming	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes

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Services Provided by Pharmacy Vendors or PBMs in Medicaid Fee-for-Service Benefit

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Services Provided by Pharmacy Vendors or PBMs in Medicaid Fee-for-Service Benefit

As of July 1, 2019

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