Delivering state government solutions to help you build healthier communities
With 40+ years of Medicaid pharmacy experience, we provide person-centered support to 54 million Americans enrolled in state government programs. By delivering affordable, reliable services that help improve health outcomes and ensure coordination of care, we help your members access the resources they need to live healthier lives.
FLEXIBLE PARTNERSHIP
Innovative state government solutions
Providing choice in Medicaid delivery models
With Prime and Magellan Rx, you’ll receive the expertise and flexibility you need to help control costs and optimize member care. We provide:
- Traditional Fee-for-Service (FFS) models
- Medicaid pharmacy benefits carved out of managed care organization (MCO) agreements
- PBM services in which we contract with your state Medicaid program and MCOs
Managing affordability of cell and gene therapies
Experts predict that the FDA will approve 10–20 cell and gene therapy products each year starting in 2025.1 These therapies offer renewed hope for people living with highly complex conditions, but they often carry an ultra-high-cost burden for members and plans.
Tackling the challenges of high-cost PADs
Many physician administered drugs (PADs) are extremely costly for state Medicaid departments and members. With PAD Advisor, you have help identifying and implementing utilization management measures to drive to the lowest-cost clinically effective medicines. This solution also provides a fee schedule to help ensure appropriate provider reimbursement.
Managing chronic conditions with care
People living with chronic conditions and the providers who treat them face unique challenges. One of the most prevalent chronic conditions is diabetes, affecting up to 14.7% of Americans.4 We support Medicaid FFS plans and members by managing the cost of diabetic supplies through our multi-state Diabetic Supply Program supplemental rebate pool.
OUR SOLUTIONS
Differentiated programs that meet your needs
We support Medicaid pharmacy benefits and AIDS Drug Assistance Programs (ADAPs) through a comprehensive suite of state government solutions. Our pharmacy benefits administration (PBA) solution has been CMS certified for 17 years, and is now certified in 15 states, having received each certification on the first attempt with no findings. We work closely with you to meet statutory and regulatory requirements in the continually changing health care environment.
Flexible POS solution
Our point-of-sale (POS) solution helps ensure accurate claims adjudication so members get the right drugs at the right time. Automated prior authorization and lab value integration make collecting claims data more efficient and accurate.
Market-leading PDL programs
We implemented the country’s first Medicaid FFS preferred drug list (PDL) program in 2001. And we’re still the pioneer in this space, offering individual state PDL programs and two of the nation’s three PDL pools, National Medicaid Pooling Initiative and The Optimal PDL $olution.
Rebate management
We help states successfully implement and operate within the Medicaid Drug Rebate Program, invoicing manufacturers so states see maximum rebates. And we pass through to our state clients 100% of rebates collected.
ADAP
We have 25 years of experience administering ADAPs to meet state needs. With our ADAPs, you’ll receive an efficient and cost-effective program that helps ensure patients living with HIV/AIDS can access lifesaving medications.
STATE GOVERNMENT SOLUTIONS RESOURCES
Expert knowledge from the brightest minds in pharmacy
As a service-centered pharmacy benefits partner with deep thought leadership expertise, we share information to help you make the best decisions for your members.
Partnering with Medicaid to Effectively Manage Physician Administered Drugs
In this episode of Beyond the Script, join Jami Snyder, Ann Walker and Tina Hawkins, PharmD to learn more about the need for states to closely manage physician administered drugs and how Prime/MRx is meeting the needs of state Medicaid programs with its market leading solution, PAD Advisor.
Delivering the latest Medicaid trend insights
In the eighth edition of our annual Medicaid Pharmacy Trend Report™, you’ll find insights about drug spend trends across Medicaid programs to help you best position your business for the future.
Achieving ISO recertification
Magellan Medicaid Administration, LLC, our PBA solution, was recertified in late 2023. Our ISO 9001:2015 certification means we offer quality management systems that focus on continuous improvement, customer satisfaction and a process-based approach.
1 U.S. Food & Drug Administration. (2023, December 8). FDA Approves First Gene Therapies to Treat Patients with Sickle Cell Disease. https://www.fda.gov/news-events/press-announcements/fda-approves-first-gene-therapies-treat-patients-sickle-cell-disease
2 Magellan Rx Management. (2022, November 18.) Medical Pharmacy Trend Report 2022. issuu. https://issuu.com/magellanrx/docs/medical_pharmacy_trend_report_2022?fr=sNWlwNzU2MDk50DQ
3 DeMartino, P., Haag, M. B., Hersh, A. R., Caughey, A. B., & Roth, J. A. (2021). A budget impact analysis of gene therapy for sickle cell disease: The Medicaid perspective. Obstetrical & Gynecological Survey, 76(12), 727-729. https://doi.org/10.1097/01.ogx.0000802672.82817.88
4 Centers for Disease Control and Prevention. (2024, January 8). National Diabetes Statistics Report. https://www.cdc.gov/diabetes/php/data-research/?CDC_AAref_Val=https://www.cdc.gov/diabetes/data/statistics-report/index.html