The Idaho Medicaid Pharmacy Report is our contribution to the effort to create a comprehensive, affordable prescription drug program for the senior citizens of Idaho. It is a project of the Heinz Family Philanthropies. Jeffrey R. Lewis, President of the Heinz Family Philanthropies (jlewis@heinzoffice.org), prepared this report, with technical support from Mercer Government Human Services Consulting. To view the report, click the section titles below. Entire Report (PDF) Acknowledgements About the Authors Executive Summary Summary of Opportunities Introduction Methodology Plan Design Analysis Pharmacy Reimbursement Financial Arrangement with Vendors Pharmacy Claims Processing Management Programs—DUR Edits Pharmacy Claims Processing Management Programs—Prior Authorization Fraud and Abuse Programs Claims Data Fields Utilization Management Opportunity — Dose Consolidation Utilization Management Opportunity — Quantity Limitations Reimbursement Opportunity — Specialty Injectables Utilization Management Opportunity — Step Therapy Pricing Opportunity — Pill-Splitting Program Utilization Management and Pricing Opportunity — Enhanced Prior Authorization Program and Supplemental Rebates Appendices Appendix A Appendix B Appendix C Appendix D Appendix E Back to Top