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Pharmacy benefits are changing in many state Medicaid programs. Photo: Scott Olson/Getty Images

Michigan's Medicaid program is proposing to fire the pharmacy benefit managers that handle its prescription drug claims and negotiate prices. The state would manage drug coverage itself, starting Dec. 1.

The big picture: More state Medicaid agencies have determined that outsourcing all negotiations and operations of prescription drugs to PBMs has not produced the dramatic savings they were promised.

Details: Michigan officials said in a bulletin the state could extract bigger rebates from pharmaceutical companies and cut administrative costs if the state handled all Medicaid medication benefits, instead of the current private contractors.

  • Michigan would use Magellan as its sole drug claims processor.
  • A spokesperson for the Michigan Department of Health and Human Services said the proposal would save $40 million, and officials "will be reviewing the feedback carefully to determine next steps."
  • CVS Health, OptumRx, MedImpact and a handful of other PBMs stand to lose business.

Between the lines: State governments, along with pharmacists, continue to lead the crusades against PBMs.

  • A recently signed California regulation will shift all Medicaid drug benefits away from PBMs by 2021, and West Virginia's Medicaid department fired its PBMs in 2017.

Go deeper

Home confinees face imminent return to prison

Illustration: Aïda Amer/Axios

Thousands of prisoners who've been in home confinement for as long as a year because of the pandemic face returning to prison when it's over — unless President Biden rescinds a last-minute Trump Justice Department memo.

Why it matters: Most prisoners were told they would not have to come back as they were released early with ankle bracelets. Now, their lives are on hold while they wait to see whether or when they may be forced back behind bars. Advocates say about 4,500 people are affected.

The "essential" committee that still doesn't exist

House Speaker Nancy Pelosi. Photo: Stefani Reynolds/Getty Images

Nearly five months after House Speaker Nancy Pelosi (D-Calif.) announced the creation of the bipartisan Select Committee on Economic Disparity and Fairness in Growth, it's not been formed much less met.

Why it matters: Select committees are designed to address urgent matters, but the 117th Congress is now nearly one-quarter complete without this panel assembling. When she announced this committee, Pelosi described it as an "essential force" to "combat the crisis of income and wealth disparity in America."

Biden's ethics end-around for labor

President Biden surveys a water treatment plant during a visit to New Orleans today. Photo: Brendan Smialowski/AFP via Getty Images

The Biden administration is excusing top officials from ethics rules that would otherwise restrict their work with large labor unions that previously employed them, federal records show.

Why it matters: Labor's sizable personnel presence in the administration is driving policy, and the president's appointment of top union officials to senior posts gives those unions powerful voices in the federal bureaucracy — even at the cost of strictly adhering to his own stringent ethics standards.