House approves Medicaid pharmacy changes, sponsor cites Milliman cost study

The Utah House on March 3, 2025, approved House Bill 409, which adjusts how the Medicaid pharmacy benefit is delivered. Representative Bollinger, who presented the bill, said the measure follows recommendations of a commissioned Milliman study.

Why it matters: Medicaid pharmacy payments affect the state budget and the delivery of prescription services to Medicaid enrollees. Representative Bollinger said the current system with accountable care organizations (ACOs) has added cost and that the bill adopts the study's largest cost-saving recommendation.

Floor explanation and rationale

Representative Bollinger summarized the Milliman study in explaining the bill's purpose: the report concluded that ACOs were not serving the state as intended and that a fee-for-service structure for pharmacy benefits would reduce costs. "This bill actually takes their biggest cost saving suggestion to the state and changes that to a fee for service structure," Bollinger said on the House floor.

The sponsor invited questions but senators or members did not record extended floor debate beyond the sponsor's presentation. Supporters on the floor characterized the measure as responsive to actuarial review and intended to reduce program costs.

Vote and disposition

Voting was opened and closed on the floor; the House recorded 71 yes votes and 0 nos. The bill will be transmitted to the Senate for further consideration and any required fiscal or implementation work.

Implementation notes

Representative Bollinger said the change responds to the legislature-commissioned evaluation; he did not specify an implementation timetable or the estimated dollar savings on the House floor. The Department of Health and Medicaid will be the implementing agency if the bill becomes law.