The September and October editions of our 5 Slide Series provides our tabulations and analysis of the NCQA Quality Ratings for Medicaid MCOs (September edition) and Medicare MCOs (October edition) in Rating Year 2019-2020. We looked at the national distribution of MCO ratings, calculated average ratings for large multi-state chain MCOs, and reported the highest rated plan in each state (or plans if there was a tie).
PCMA engaged The Menges Group to estimate the financial and programmatic value of managing the prescription drug benefit in the Medicaid managed care setting, comparing states that utilize MCOs – who contract with PBMs – for their prescription drug benefits to states that manage their prescription drug benefits in FFS. Using Medicaid prescription drug data reported by each state to the Centers for Medicare and Medicaid Services (CMS) for all Medicaid-paid pharmacy-dispensed prescriptions, we analyzed how prescription drug costs and usage vary depending on how prevalent managed care is in each state Medicaid program. We also analyzed the drug costs and usage within specific therapeutic drug classes.