Medicaid Reform capitated health plans have more flexibility in developing their preferred drug lists than do traditional Medicaid plans. Although the Agency for Health Care Administration expects plan beneficiaries to have access to the same drugs that would be available to them under traditional Medicaid fee-for-service, it relies on plans' assurances that they will provide the drugs needed by their beneficiaries. While the agency has some processes to identify problems beneficiaries experience related to receiving drugs, oversight can be improved. Our analyses showed that Reform capitated plans' preferred drug lists do not contain all of the drugs or therapeutic classes of drugs available through Medicaid fee-for-service. While not listing a drug does not necessarily mean the plan will not cover the drug, beneficiaries may have to go through additional steps such as obtaining prior authorization or step therapy before they can receive the drug.
Although obtaining information about prescription drug coverage is important to many Medicaid beneficiaries, it is difficult for them to locate and compare Reform plans' drug offerings and prior authorization requirements. To address this issue, the agency has established a special needs unit to help beneficiaries determine which plans cover the drugs they need. In addition, the agency is developing an electronic tool that choice counselors can use to help beneficiaries compare prescription drug coverage among the plans.

Medicaid Reform: Legislature Should Delay Expansion Until More Information Is Available to Evaluate Success
Report 09-29 June 2009
Medicaid Reform: Reform Provider Network Requirements Same as Traditional Medicaid; Improvements Needed to Ensure Beneficiaries Have Access to Specialty Providers
Report 08-64 November 2008
Medicaid Reform: Risk-Adjusted Rates Used to Pay Medicaid Reform Health Plans Could Be Used to Pay All Medicaid Capitated Plans
Report 08-54 September 2008
Medicaid Reform: Choice Counseling Goal Met, But Some Beneficiaries Experience Difficulties Selecting a Health Plan That Best Meets Their Needs
Report 08-46 July 2008

Copies of this report in print or alternate accessible format may be obtained by email OPPAGA@oppaga.fl.gov, telephone (850) 488-0021, or mail 111 W. Madison St., Room 312 Tallahassee, FL 32399-1475.