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.
This edition presents our tabulations of Medicaid pharmacy cost and price trends. Some of our key findings:
Nationwide Medicaid pre-rebate costs per prescription increased at an annual average rate of 5.6% from 2012-2021, led by an 11.9% annual rate of increase for brand drugs. Average costs per brand drugs rose particularly sharply during recent years, rising 56 % (16% per year) from 2018-2021.
Keeping the mix of drugs constant so that price changes could be assessed, we found that drug prices rose 64% across all drugs that were on the market throughout the 2012-2021 timeframe.
During 2021, 52.1% of Medicaid’s pre-rebate prescription drug spending were attributable to medications with an average cost above $1,000 per prescription. This proportion was “only” 21.5% during 2012.
- Keywords: Expenditures Medicaid Prescription Drugs
This edition quantifies the decrease in Medicaid prescription volume that has occurred during COVID, comparing usage during calendar years 2019, 2020, and 2021. The large decrease that has occurred – 16.4% from 2019 to 2021 on a per covered person basis — is highly concerning regarding its implications regarding the poverty population’s access to needed medications during the pandemic.
- Keywords: COVID-19 Medicaid Prescription Drugs
We were enlisted by the Anthem Public Policy Institute to assess the cost-effectiveness of different states’ approaches to managing Medicaid prescription drug benefit. States were grouped into five cohorts depending on the degree to which their Medicaid prescriptions are paid for by MCOs or via the fee-for-service (FFS) setting – and by the degree of latitude MCOs have to manage the mix of drugs. We assessed 100% of Medicaid prescriptions across federal fiscal years 2018, 2019, and 2020.
- Keywords: Expenditures Medicaid Prescription Drugs
This edition of our 5 Slide Series examines excess deaths at the state level during the pandemic. Taking the difference of average monthly deaths during the pandemic and a pre-pandemic average, we find that states in the South and Southwest have experienced the largest percentage increase in deaths above normal. In addition, despite experiencing a particularly deadly first wave in the spring of 2020, New England states have collectively experienced the lowest number of excess deaths per capita; we find that 5 of the 11 states with the least number of excess deaths per capita are in this region. Second, we estimate excess deaths among different cohorts, including age, race/ethnicity, and cause of death. For age, we find that the 25–44 age bracket experienced the sharpest percentage increase in all-cause observed deaths in 2020 and 2021 compared to its 2015-2019 historical average. For race, we find that Hispanics experienced the sharpest percentage increase in all-cause observed deaths in 2020 and 2021, followed by American Indians/Alaska Natives and Asians. Lastly, we use cause of death data to confirm that deaths from Alzheimer’s disease/dementia increased the most during the pandemic, followed by deaths from circulatory disease. This latter finding dovetails with our February 4th edition, which showed that COVID deaths have likely been substantially undercounted. The spike in Alzheimer’s deaths could involve COVID death categorization dynamics.
- Keywords: COVID-19
This edition examines the impact of the pandemic on overall deaths in 2020 and 2021. Comparing excess deaths (deaths above the pre-COVID annual average) at the national level from April 2020 to December 2021, we find that annual deaths in the US were more than one-fifth higher in 2020 and 2021 than they were on average between 2017 and 2019. We calculate 1.09 million excess deaths have occurred during the pandemic to date, which is about 264,000 (32%) above the number of COVID-confirmed deaths during this time (831,000). We also find the population-adjusted per capita death rate increased by 18% during the pandemic years compared to the pre-pandemic baseline – well above the second largest annual death increase in the last twenty years experienced between 2014 and 2015 (2.5%).
- Keywords: COVID-19
This edition reexamines COVID case, death, and vaccination trends in the wake of the new (potentially more contagious) Omicron variant. Cases and deaths in 2021 have already eclipsed 2020 figures. More than 28 million cases have been reported in 2021 – about 40% higher than in 2020. Nearly 408,000 deaths have been reported so far throughout 2021 – well above the nearly 360,000 reported in 2020.
- Keywords: COVID-19
This edition of our 5 Slide Series examines state Medicaid spending during Federal Fiscal Year 2020. Using expenditure reports from CMS, we calculated the share of each state’s Medicaid spending that occurred via capitation. Capitation represented the majority (52.6%) of nationwide Medicaid expenditures during 2020, followed by fee-for-service claims payments (40.1%) and special financing programs (7.3%). Use of a comprehensive care coordination model centered around capitation contracting has grown sharply throughout the past decade, increasing from 27% of national Medicaid spending during 2010 to 53% in 2020. In 22 states capitation represented a majority of Medicaid spending during 2020.
- Keywords: Expenditures Medicaid
This edition revisits pediatric COVID-19 trends in the United States. Schools have now been opened for several weeks, providing an opportunity to assess the initial effects of student gatherings in classrooms. We observe decreasing, albeit still extremely high, pediatric case counts during the week ending in September 23, with children composing 27% of all new cases – more than double their share reported during the first week of January. Around 200,000 new pediatric cases are being reported each day.
- Keywords: COVID-19
In this edition of our 5 Slide Series, we return to presenting COVID death trends, as the pandemic’s recent resurgence merits significant attention. Average daily deaths across the prior 7-day period were 361 on June 13, 274 on July 13, 650 on August 13, and 1,827 on September 13. Every two days, more Americans are currently dying of COVID than perished in the September 11, 2001 terrorist attacks. We break down these death numbers by state political lean, finding that states with Republican governors and majority Trump 2020 vote share have much higher per capita death rates, and compose a disproportionate share of national deaths compared to their share of the population.
- Keywords: COVID-19
This edition of our 5 Slide Series coincides with today’s release of a new report, “Assessment of Medicaid Expansion’s Impacts.” The 5 Slide Series creates an opportunity for our staff team to contribute to the Medicaid industry outside the boundaries of our project work, and this report represents a more significant effort of that nature.