New Hampshire Medicaid implements pharmacy management changes to enhance care quality

The New Hampshire Health and Human Services Oversight Committee meeting on April 25, 2025, spotlighted significant advancements in Medicaid management, particularly in pharmacy benefit management and quality improvement strategies.

A key highlight was the introduction of a shared risk pool for high-cost pharmacy items, including over 70 biologic and gene therapies. This innovative approach aims to ensure that managed care organizations (MCOs) are fully engaged in the responsible use of these expensive treatments, which can have substantial long-term benefits for patients. The initiative is designed to prevent wasteful spending while maximizing the therapeutic impact of these therapies.

Additionally, the committee discussed enhancements to the pharmacy benefit management system, which now includes reimbursement for medication reviews conducted by providers. This change is part of a broader effort to improve patient safety and medication management, particularly for those on multiple prescriptions—a concern known as polypharmacy.

The meeting also addressed the Medicaid quality strategy, which aligns with federal regulations and focuses on improving access to care and the overall quality of services provided to beneficiaries. The strategy includes performance-based incentives for MCOs, which are designed to encourage timely access to care and enhance the patient experience.

Committee members expressed concerns about rising healthcare costs and the sustainability of family practice medicine, emphasizing the need for ongoing support and awareness of billing opportunities for primary care providers. The discussions underscored the importance of collaboration between the state and healthcare providers to ensure that quality care remains accessible to all New Hampshire residents.

As the committee moves forward, the implementation of these strategies is expected to play a crucial role in shaping the future of Medicaid services in the state, with a focus on improving health outcomes and managing costs effectively.