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5 Slide Series

Our 5 Slide Series allows us to regularly present objective analyses and trends on issues we believe are of interest and share our findings through data tabulations and visualizations.

The health policy cows are back for April’s report, which presents data and opinions regarding the need to pilot-test implementing managed care in the Medicare arena in a similar manner as typically occurs in Medicaid — mandatory enrollment of beneficiaries into a small number of competitively selected MCOs.

This month’s edition aggregates the financial performance of the nine largest US health insurers and presents these companies’ revenues, expenses, taxes, and net income from 2012 to 2015. This comparison reveals substantial growth in the health insurance industry with consistent yearly profit margins, even after paying sizeable amounts of income taxes.

The February report pieces together different data on prescription volume by state – mostly through our staff’s tabulations – showing the distribution of each state’s total 2015 prescriptions between those paid by Medicaid, Medicare Part D, and all other payer sources combined. There was considerable variation in this percentage distribution in each state.

This edition provides data on Medicaid prescription drug usage and costs and trends from 2013 to 2015. Each data table shows national totals and subtotals for three groups of states: non-expansion states, initial Medicaid expansion states (those implementing Medicaid expansion in January 2014), and subsequent expansion states. The tables show all Medicaid-paid pharmacy volume, including prescriptions paid by Medicaid MCOs and those paid in the Medicaid fee-for-service setting. Tables differentiate pre-rebate and post-rebate spending.

This edition encourages states to ascertain (and fix) situations where providers are securing prices far above Medicaid fee-for-service by way of a leveraged negotiation outcome with the Medicaid health plans in their market area. This dynamic, in our view, is often negating the taxpayer savings that the Medicaid health plans’ excellent care coordination work would otherwise be achieving.

For the November edition of the Five Slide Series we tabluated the costs and usage of three prevalent Hepatitis C medications – Sovaldi, Harvoni, and Viekira Pak. These drugs have all been introduced within the last 2 years and have exploded in popularity over that span, despite the high prices they command. In this slide deck we look at these drugs on a state-by-state basis, as well as on the national level.

This October edition of the Five Slide Series quantifies the monthly influx of the Medicaid expansion population through March of 2015. Expansion enrollment increased throughout the 15 month period in 14 of the 15 states reviewed.

This September edition of the Five Slide Series is a set of projections of the degree to which each state’s Medicaid program will be “capitated” in 2016. Nationally and in several states, substantial movement to the capitated model has occurred in recent years and this constitutes “true health reform” – fundamentally changing how Medicaid services are being accessed, delivered, and paid for.

This August issue of the Five Slide Series challenges some “sacred cows” in health policy. The format is a bit unusual – we hope you enjoy reading it and that the content is useful.

We tabulated the cost per prescription for FFY 2014 using a 100% sample of Medicaid-paid prescriptions in each state. Medicaid’s national average net (post-rebate) cost per prescription was $37 in 2014. Initial (pre-rebate) payments to pharmacies averaged $72 per prescription; rebates averaged $35 per prescription. Net costs per prescription at the state level ranged from a low of $24 in Rhode Island to a high of $60 in Connecticut.

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