Current contract holders are Anthem, CareSource, and Centene (PeachState), serving more than 1.9 million beneficiaries as of May 2022. Existing contracts run through June 30, 2024. The request for proposals is expected to be released in late 2022 or early 2023. The Georgia Academy responded to the RFI submitting over seven pages of how Georgia’s Medicaid system could be improved. Chapter President Dr. Susana Ajoy Alfonso noted in our cover page the following:
On behalf of the 3,200 members of the Georgia Academy of Family Physicians, we are submitting suggested recommendations for consideration by the Department as you craft the new (and anticipated) request for proposals for insurance companies focusing on the Medicaid population. Thank you for allowing us to compile suggestions for quality improvement that help our patients and brings savings to the state of Georgia.
While we are submitting separate information through your RFI process, note that we work closely with our primary care physician and OB Gyn society partners through the Patient-Centered Physician Coalition of Georgia which represents over 10,000 family physicians, pediatricians, internal medicine physicians, obstetricians/gynecologists, and physicians of osteopathic medicine.
We look forward to providing continuous feedback and collaboration through this process.
Some of the suggestions that were submitted to Georgia’s Medicaid include the following:
- The Georgia Medicaid program should encourage innovative ideas as medicine and technology are constantly changing.
- DCH should consider a forum whereby clinicians and/or patients and families can propose innovative ideas and best practices such as-
- Automatic Behavior medicine assessment for all patients with uncontrolled chronic diseases
- Coverage for standalone pharmacy services such as for uncontrolled diabetics
- Community grants which address novel ways to combat SDoH challenges
- Prior authorization reform needs to occur both for behavioral and physical health– similar to what has occurred in Ohio. Ohio is implementing a fiscal intermediary that will serve as a single point of entry for prior authorization requests.
Additional information can be found here:
- https://managedcare.medicaid.ohio.gov/managed-care/ohio-next-generation-managed-care-2
- https://bh.medicaid.ohio.gov/Provider/Medicaid-Managed-Care-Plans
Uniform Preferred Drug Lists
States can establish a uniform PDL (or single PDL) across both managed care organizations and FFS. This is a strategy that states are employing for administrative efficiency and ease, to increase transparency, and maximize drug rebates.
States with a Uniform PDL
The most recent state-by-state analysis that was conducted of state policies regarding uniform PDLs was in 2019 by the Kaiser Family Foundation with support from HMA. In that survey, 16 states reported having a uniform PDL for some or all drug classes as of July 2019. Those states are:
Uniform PDL for all drug classes:
Arkansas
Delaware
Iowa
Kansas
Louisiana
Minnesota
Mississippi
North Dakota
Texas
Uniform PDL for some drug classes:
Arizona
Florida
Massachusetts
Nebraska
South Carolina
Virginia
Washington