Today’s Medicaid Program: Focus on Pharmacy Reimbursement Trends

ACPE UAN #:   0233-0000-16-033-H04-P

Release Date:  Friday, April 22, 2016

Expiration Date:   Friday, April 22, 2019

Activity Type:  Knowledge-based  

Contact Hours:   1.25

Activity Fee:  Member:  $15.00             Non-Member:  $30.00


As an accredited provider, AMCP strictly adheres to the ACPE Standards for Commercial Support and other relevant guidelines and standards to ensure the independence of continuing pharmacy education (CPE) activities.  It is AMCP’s intent that all CPE activities be independent, objective, balanced, evidence-based and free of any commercial bias.   

Target Audience: This repurposed session from the AMCP Annual Meeting 2016 is designed to provide insights and solutions for pharmacists who practice in managed care settings, to help them maintain and enhance their knowledge, skills, and abilities. 

Activity Overview

Almost seventy million Americans depend on Medicaid for their health insurance coverage – making this program the largest single health insurer in the United States. It is a complex program that has federal rules but is run at a state level. The program regularly seems to be the source of fiscal concern, with policymakers seeking to lower the costs of care while maintaining quality health care for low-income individuals – much like other insurers. Medicaid has evolved over the last 50 years, especially as one of the foundations of the 2010 Affordable Care Act. In the near future, more changes to the Medicaid program are expected, including changes to pharmacy reimbursement and 340B expansion. This session will provide the current landscape of Medicaid with an emphasis of recent trends such as statewide/universal preferred drug lists, prior authorizations, and 340B issues. 

Learning Objectives:  

  1. Compare and contrast the role of state-wide and universal preferred drug lists and formulary carve-outs for state Medicaid and Managed Care programs.
  2. Summarize new Medicaid rule changes for 2016.
  3. Discuss the different acquisition-based pricing formulas and the benefits of each.
  4. Describe the current challenges around 340B pricing and their impact on state Medicaid programs.

Schedule of Educational Activity

This CPE online activity consists of a pre-recorded audio/slide presentation, a pre-test (to establish prior knowledge, not required to pass), a post-test with a score of 70% or higher, and a specific online activity evaluation. 

Faculty Relevant Financial Relationships Disclosure: AMCP asks everyone who is in a position to control the content of a continuing pharmacy education activity to disclose all relevant financial relationships with commercial interests. If AMCP determines that a conflict of interest exists as a result of a financial relationship you have (or that your spouse/partner has), we will need to take appropriate steps to resolve the conflict of interest.

  • Matthew Dull, BS is an employee of Artia Solutions, LLC.
  • George O. Kitchens, RPh is an employee of Artia Solutions, LLC and a consultant for Elsevier.
  • AMCP staff report no relevant financial relationships pertinent to this activity: Puneet Singh, PharmD and Ruby Singh, PharmD, BCPS.

Method and CPE Requirements:   

Participants should claim continuing pharmacy education (CPE) credit for this online activity, only if they have not claimed credit for the live activity presented at the AMCP Annual Meeting 2016. 

CPE credit will be processed through the AMCP Learn portal and reported directly to CPE Monitor.  Please allow 24-72 hours for processing and posting in your NABP account.

To receive CPE credit for an AMCP Learn online activity you must:

  • View the entire pre-recorded audio/slide presentation.
  • Successfully complete the post-test with a score of 70% or higher (The post-test will provide feedback.)
  • Complete a specific online activity evaluation.

System Technical Requirements/Viewing Requirements: System Requirements Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities you should have a basic comfort level using a computer and navigating the web site.  View the minimum technical and system requirements for online educational activities.

Credit Information

Activity Number Credit Amount Accreditation Period
ACPE UAN #0233-0000-16-033-H04-P 1.25 Contact Hours April 22, 2016 - April 22, 2019