49.45(49m)(c)3.3. Utilization management and fraud and abuse controls.
49.45(49m)(c)4.4. Any other activity to reduce the cost of or expenditures for prescription drugs and maintain high quality in prescription drug therapies.
49.45(49m)(d)(d) The department may enter into a contract with an entity to perform any of the duties and exercise any of the powers of the department under this subsection.
49.45(49r)(49r)Value-based purchasing.
49.45(49r)(a)(a) In this subsection, “manufacturer” has the meaning given in s. 450.01 (12).
49.45(49r)(b)(b) Subject to par. (e), the department may enter into a value-based purchasing arrangement for the Medical Assistance program by written agreement with a manufacturer based on agreed upon metrics to which the department and the manufacturer agree in writing. A value-based purchasing arrangement under this paragraph may include any of the following:
49.45(49r)(b)1.1. Rebates.
49.45(49r)(b)2.2. Discounts.
49.45(49r)(b)3.3. Price reductions.
49.45(49r)(b)4.4. Risk sharing.
49.45(49r)(b)5.5. Reimbursements.
49.45(49r)(b)6.6. Payment deferrals or installment payments.
49.45(49r)(b)7.7. Guarantees.
49.45(49r)(b)8.8. Shared savings payments.
49.45(49r)(b)9.9. Withholds.
49.45(49r)(b)10.10. Bonuses.
49.45(49r)(b)11.11. Any other thing of value.
49.45(49r)(c)(c) Nothing in this subsection may be interpreted to require a manufacturer or the department to enter into an arrangement described under par. (b).
49.45(49r)(d)(d) Nothing in this subsection may be construed to alter or modify coverage requirements under the Medical Assistance program.
49.45(49r)(e)(e) If the department determines it is unable to implement this subsection without a waiver of federal law, state plan amendment, or other federal approval, the department shall request from the secretary of the federal department of health and human services any waiver of federal law, state plan amendment, or other federal approval necessary to implement this subsection. If the federal department of health and human services does not approve a waiver of federal law, state plan amendment, or other federal approval under this paragraph, the department is not required to implement this subsection.
49.45(50)(50)Disease management.
49.45(50)(a)(a) In this subsection, “disease management” means an integrated and systematic approach for managing the health care needs of patients who are at risk of or are diagnosed with a specific disease, using all of the following:
49.45(50)(a)1.1. Best practices.
49.45(50)(a)2.2. Prevention strategies.
49.45(50)(a)3.3. Clinical practice improvement.
49.45(50)(a)4.4. Clinical interventions and protocols.
49.45(50)(a)5.5. Outcomes research, information, and technology.
49.45(50)(a)6.6. Other tools and resources to reduce overall costs and improve measurable outcomes.
49.45(50)(b)(b) The department may contract with an entity, under the department’s request-for-proposal procedures, to engage in disease management activities on behalf of recipients of medical assistance.