Under the direction of its new governor, Democrat Gavin Newsom, California is planning to take control of the pharmacy benefit for all of the state’s Medi-Cal beneficiaries, AIS Health reported.

Medi-Cal, California’s Medicaid program, is served by more than 20 managed care organizations. MCOs are currently able to contract with a pharmacy benefits manager, but the new plan would allow the state to directly negotiate drug prices, purchase drugs in bulk and develop transparency on drug cost reimbursement.

With nearly 90% of the state’s 12.1 million Medicaid beneficiaries enrolled in managed care, a shift to fee-for-service would entirely upend existing PBM relationships in Medi-Cal, the largest managed Medicaid program in the U.S.