As state legislatures grappling with budget shortfalls search high and low for every possible angle to cut costs, big insurance companies and pharmacy benefit managers have managed to convince a handful of states to transition their Medicaid programs into a "Managed Care" model. 

The insurers and PBMs promise the legislatures big savings – though it's not clear they will deliver – and encourage the states to hand over taxpayer dollars for Medicaid to Fortune 500 companies and cut independent pharmacists and their customers out of the loop. 

In the private sector, benefits managers should take a careful look at their existing contracts with their pharmacy benefit manager to make sure the contracts are transparent and any savings are being passed from the PBM to the employer.  The oldest trick in the PBM playbook is to encourage benefits managers to sign misleading contracts which prohibit the plan sponsor from knowing how much the PBM is reimbursing the pharmacist.  That lack of transparency allows the PBM to overcharge the employers for prescription drugs and pocket the difference as profit.