Abarca selected as pharmacy benefit manager for Puerto Rico Medicaid program

PBM implements benefits for 1.3 million Medicaid members in just 10 days

Aventura, FL — Abarca, a pharmacy benefit manager (PBM) transforming the industry with a new approach to technology and business practices, is now serving as the PBM for Vital, a Medicaid program managed by the Puerto Rico Health Insurance Administration (ASES). After being selected through an open, competitive RFP process in January of this year, Abarca began its contract on May 1, 2022, following a historic implementation accomplished in only ten days.

“The Medicaid population of Puerto Rico deserves the best possible healthcare experience,” said Jason Borschow, president & CEO of Abarca. “We’re looking forward to expanding our relationship with ASES to deliver just that.”

Under the contract award, Abarca was scheduled to begin administering benefits to Vital members on January 1, 2023. However, after ASES and the incumbent PBM did not agree on the terms of a contract extension, Abarca accelerated its implementation and began administering benefits on May 1, 2022 – seven months ahead of schedule.

Despite this accelerated timetable, Abarca seamlessly transitioned various essential services, including claims processing, formulary management, and network contracting and payments management, within ten days to ensure no disruption in benefits for Plan Vital’s 1.3 million Medicaid members.

“We are very satisfied with the completed process, which resulted in Abarca’s award of the full-service PBM contract. Medicaid patients in Puerto Rico have the right to receive health services of excellence and quality, which has distinguished Abarca since our relationship in 2006. We look forward to continuing working with Abarca to meet these goals” said Edna Marin, executive director of the Puerto Rico Health Insurance Administration.

Abarca began working with ASES in 2006 as the program’s pharmacy program administrator (PPA). In its new role, Abarca will act as the full-service PBM for Vital, including implementing a new rebate management model, the Medicaid Drug Rebate Program.

To learn more about Abarca’s pharmacy benefit services, visit abarcahealth.com.

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