Investor Presentaiton
Figure 11: Many states have adopted policies for uniform preferred drug lists for all or some drug classes in
Medicaid coordinated care
AK
HI
WA
MT
ND
MN
WI
MI
ME
VT
NH
NY
MA
RI
WY
SD
ΙΑ
IN
OH
PA
NJ
OR
NV
CO
NE
MO
KY
WV
VA
MD
DE
40
CA
UT
NM
KS
AR
TN
NC
SC
DC
No uniform preferred
AZ
OK
LA
MS
AL
GA
TX
FL
drug list for managed
care
FFS pharmacy benefit
Uniform preferred drug
list for some drug classes
Uniform preferred drug
list for all drug classes
Source: Kaiser Family Foundation
Another patient protection other states have implemented is requiring PBMS to act as a fiduciary.
Fiduciaries are organizations acting on behalf of another person or entity, with a duty to preserve good
faith and trust, putting their client's interests ahead of their own. Fiduciaries are legally and ethically
bound to act in the best interest of the people they serve.
Several states require all PBMs operating within the state, including commercial and Medicaid PBMs, to
sign contracts that include fiduciary clauses. According to these clauses, not only will the PBM act in
the best interest of the insurer they subcontract with, but they will also act in the best interest of the
beneficiaries of the insurer. This helps ensure the PBM will act in their self-interest only if the act does
not harm or reduce value to the program or the person. State Insurance Commissions are typically the
oversight body in states that have adopted this leading practice.
States with fiduciary clauses
California, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Minnesota, Nevada, New Jersey, New York,
Oklahoma, South Dakota, and Vermont.
Pay-for-performance contracts create confusion and obstacles to transparency
CCOs may choose between contracting with OPDP or selecting a different PBM to provide services, as
they almost all have. CCOS might choose to use a different PBM, rather than OPDP, because they offer
other insurance plans outside of Medicaid that they already have a contracted PBM for. If CCOS choose
to use a different PBM, they can decide between two contract types: pass-through or pay-for-
performance. A pass-through contract states the PBM will pass through any negotiated manufacturer
Oregon Secretary of State Report 2023-25 | August 2023 | page 17View entire presentation