Tag: Expenditures
This month’s edition investigates prescription drug spending in all 50 states across three major state health care payers: Medicaid, state employee health plans, and in state prisons. By comparing these expenditures to total health care spending and overall spending in each state, one gets a better idea of the relative extent of state spending on prescription drugs.
- Keywords: Expenditures Medicaid Policy Prescription Drugs
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.
- Keywords: Expansion Expenditures Medicaid Prescription Drugs
We were asked by the Association for Community Affiliated Plans (ACAP) to estimate the Medicaid savings created by the capitated coordinated care model. The report estimates the savings each state is achieving with its existing capitation program, as well as the additional savings that will occur if remaining fee-for-service Medicaid spending in each state is transitioned to capitation through contracts with managed care organizations (MCOs). Savings estimates are provided within each state for each major Medicaid eligibility group. Nationwide savings from existing Medicaid MCO capitation programs are estimated at $2.1 billion in 2011, increasing to $6.4 billion in 2016.
- Additional Resources: Press Release
- Keywords: Expenditures Medicaid
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.
- Keywords: Expenditures Medicaid Prescription Drugs
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.
- Keywords: Expenditures Medicaid
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.
- Keywords: Expenditures Medicaid Prescription Drugs
The May 2015 edition portrays the distribution of all Medicaid prescriptions by their unit cost corridor. These slides quantify the rapid growth in Medicaid prescriptions with a cost per prescription above $1,000. The high-cost medications in this corridor represented 1.3% of pre-rebate Medicaid pharmacy spending in 2005 but have increased to 28.4% of Medicaid pharmacy spending in 2013 and 32.6% of Medicaid pharmacy spending in 2014.
- Keywords: Expenditures Medicaid Prescription Drugs
This report summarizes Medicaid’s pharmacy costs during 2013 and 2014 and demonstrates the importance of viewing these expenditures on a net, post-rebate basis. Rebates accounted for 48.5% of the initial amount paid to pharmacies for Medicaid prescriptions during 2014, for example. The report also conveys the usage and cost information that is publicly available to date for Sovaldi.
- Keywords: Expenditures Medicaid Prescription Drugs
This edition of the Five Slide Series estimates the amount each states’ residents are paying for the Medicaid expansion population’s coverage – whether or not their state is participating in the coverage program. In the aggregate, we estimate that an annual financial transfer of $17 billion is occurring from the residents of the non-expansion states to the residents of the expansion states. A state not yet participating in the expansion can move its residents from collectively being large-scale net losers to a large-scale net gainers by opting to participate.
- Keywords: Expansion Expenditures Medicaid
This edition looks at Medicaid and Medicare combined costs. Nationwide, 2009 combined claims-based spending on Medicaid and Medicare represented approximately $800 billion in overall outlays, excluding most disproportionate share (DSH) and upper payment limit (UPL) supplemental payments. These claims-based expenditures were divided 42% for persons with Medicare coverage (but not Medicaid), 29% for persons with Medicaid coverage (and not Medicare), and 29% for Medicaid/Medicare dual eligibles. Together, Medicaid and Medicare represented 5.6% of Gross Domestic Product (GDP), $2,582 per resident, and $5,740 per working person above age 16, (excluding active duty military personnel).
- Keywords: Expenditures Medicaid Medicare