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Assessment of Report on Impacts of West Virginia Medicaid Prescription Drug Carve-Out

America’s Health Insurance Plans (AHIP) engaged The Menges Group to assess West Virginia’s Medicaid pharmacy carve-out impacts, analyzing the findings of another consulting firm’s report.  Our analyses suggest that West Virginia’s carve-out has created increased Medicaid expenditures rather than savings.  We also provide a large volume of evidence from states that switched to a carve-in approach (comparing their cost per prescription progression to states that maintained their carve out model).  These results, taking into account all Medicaid pharmacy claims and rebates in 13 states and across a several year comparison timeframe, compellingly indicate that the carve-in model has yielded large-scale savings relative to the carve-out approach. 

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