Pharmacy Plus Demonstration Initiative
Introduction
Section 1115 demonstration authority may be used to extend pharmacy coverage to certain low-income elderly and disabled individuals who are not otherwise eligible for Medicaid. The demonstrations may offer assistance by providing pharmaceutical products, assisting individuals who have private pharmacy coverage with high premiums and cost sharing, or provide wraparound pharmaceutical coverage to bring private sources of pharmacy coverage up to the level of desired demonstration benefit coverage. The demonstrations may include incentives for individuals with private pharmacy coverage not to drop their existing coverage in favor of demonstration pharmacy coverage. States are encouraged to adopt competitive private sector approaches to provide more cost effective, modern prescription drug benefits in Medicaid. The demonstrations will test how provision of a pharmacy benefit to a non-Medicaid covered population will affect Medicaid costs, utilization, and future eligibility trends.
Pharmacy Demonstrations Program Status
Pharmacy Plus Demonstration: Program Summary
Pharmacy Plus Templates- Template Summary
- Template Application - PDF 279KB
- Template Budget Neutrality Instructions and Worksheets - ZIP 15KB
- Template Sample Terms and Conditions - PDF 203KB
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