Accountable Care Organizations (ACO)
- Beginning January 1, 2013 ACOs are responsible for prescription benefits.
- ACOs should be billed for pharmacy benefits for all drugs except for the following that have been carved out:
- Hemophillia treatment drugs
- Immunosuppresant drugs used for organ transplants
- Pshycotherapeutic drugs as defined as:
- Antipsychotics
- Anti-depressants
- Anticonvulsant/mood stabilizers
- Anti-Anxiety Benzodiazepines
- Attention deficit hyperactivity disorder Stimulants
- Specific Addiction Therapy Drugs that include: Suboxone, naltrexone (Vivitrol), Revia, Methadone clinic therapy methadone, Campral, disulfiram (Antabuse).
- Carved out drugs remain the responsibility of Medicaid.
- Clients who continue to receive pharmacy benefits directly from Medicaid Fee-For-Service include new enrollees for up to 3 months, Primary Care Network (PCN) clients, and clients who go into nursing homes for greater than 30 days.
Project Contacts:
| State of Utah | Goold Health Systems |
|---|---|
| Project Lead: Bobbi Hansen bohansen@utah.gov 801-538-6339 |
Project Lead: Eliza Mathias emathias@ghsinc.com 207-622-7153 x1102 |
| Technical Lead: Nanette Epstein nepstein@utah.gov 801-538-6218 |
ACO Websites:
Health Choice | Healthy U | Molina | SelectHealthAny project documentation, FAQs, or general information that contains PHI or proprietary information will be shared with individual ACO using secure protocols.
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