Building upon our 2014 report titled Prescription Drug Adherence in Medicaid Managed Care, this report provides updated analyses performed on medication adherence, assesses the impacts of Medicaid expansion and the COVID-19 pandemic on medication adherence, and offers recommendations for further improvement to Medicaid medication access and adherence.
This edition summarizes our tabulations of several key Medicaid prescription drug cost and usage trends across the 2018-2022 timeframe. Our findings include:
• Pre-rebate costs per Medicaid prescription grew sharply, at an average annual rate of 9.7% from 2018-2022.
• Prescriptions per Medicaid enrollee have trended steadily downward since the onset of the COVID-19 pandemic.
• Pre-rebate MCO costs per prescription were 38.2% below the corresponding fee-for-service (FFS) figure in 2018 but this differential was less than half as wide (16.6%) during 2022.
• Managed care organizations (MCOs) paid for 74.3% of Medicaid prescriptions during Q4 2021. This proportion dropped to 62.5% in Q4 2022, with the decrease largely attributable to California implementing a carve-out model in January 2022.
This edition conveys some of our perspectives related to the current reinstatement of Medicaid redeterminations. This is an important time period to capture (and share) detailed information on how Medicaid enrollees can best be successfully reached, as well as the dynamics of continuous enrollment, coverage retention and loss. We delineate several specific data points that will be valuable to collect.
This edition focuses on the share of the overall population that receives Medicaid, and how this percentage has trended throughout the past decade nationally and state by state. Between Medicaid expansion, COVID dynamics, and some shifts in the economy’s performance, the past ten years have created several interesting Medicaid enrollment trends and large-scale shifts. Altogether, Medicaid enrollment jumped up 57% from 2013-2022, an increase of 36.2 million persons. Kentucky has experienced the largest rate of growth, ranking 42nd during 2013 in terms of the proportion of its overall population receiving Medicaid coverage and moving all the way to 8th as of 2022.
This edition looks at state implementation of Medicaid postpartum coverage extension and Medicaid expansion by state. We also present rates of postpartum care utilization in the Medicaid population before and after implementation of postpartum coverage extension. As of March 2023, 45 states and D.C. have implemented Medicaid expansion and/or Medicaid postpartum coverage extension.
This edition explores ways to make optimal use of available resources to help fill the extensive gaps in behavioral health care (BH) that exist in the US.
This edition looks at state-level and national Medicaid spending trends, first overall and then by the share of Medicaid spending that is paid via capitation.
This edition looks at the progression of capitation contracting in the Medicaid program at the national and state levels. As s a percentage of total Medicaid spending, capitation contracting has grown 31.1% in FFY2013 to 55.9% in FFY2021. National Medicaid spending via capitation was 47% larger than fee-for-service payments during FFY2021. In two states, Iowa and Hawaii, capitation payments represented more than 90% of overall Medicaid expenditures during FFY2021.
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.
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.