Publication
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.
5-Slide Series
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).
5-Slide Series
The June 2019 Edition was produced by Manisha Gupta and Mohammed Hamdan. It focuses on the level of marketing spending in the MCO industry, comparing the Medicaid, Medicare, and commercial sectors. On average, we found that Medicaid MCOs used 0.19% of their revenues on marketing, advertising, and commissions. These percentages were much higher among Medicare-dominant MCOs (2.26%) and commercial MCOs (3.43%).
Publication
America’s Health Insurance Plans (AHIP) engaged The Menges Group to assess West Virginia’s Medicaid pharmacy carve-out impacts, analyzing the findings of another consulting firm’s report. Our analyses suggest that West Virginia’s carve-out has created increased Medicaid expenditures rather than savings. We also provide a large volume of evidence from states that switched to a carve-in approach (comparing their cost per prescription progression to states that maintained their carve out model). These results, taking into account all Medicaid pharmacy claims and rebates in 13 states and across a several year comparison timeframe, compellingly indicate that the carve-in model has yielded large-scale savings relative to the carve-out approach.
5-Slide Series
This edition describes a Pop-Up Clinic founded and led by one of our employees, Nehath Sheriff. This type of construct could be a low-cost, high-value option to consider for organizations seeking to “meet underserved subgroups where they are.”
5-Slide Series
This month’s edition analyzes and compares prescription volume and drug costs in the Medicaid and Medicare Part D programs. We tabulated pre-rebate cost per prescription for each program from 2013-2017. We also analyzed trends in specialty drug volume and expenditures during the same time period for each program.
5-Slide Series
This edition assesses whether differences exist in overall economic performance that might help explain the Medicaid enrollment trend differences that were identified in our January 2019 edition of the Series. We have presented the unemployment rate progression from 2010 to 2017 by state, comparing aggregate unemployment rates across states that did and did not adopt Medicaid expansion.
5-Slide Series
This edition tracks the national Medicaid enrollment projection from January 2014 through September 2017, showing enrollment growth dynamics between the expansion and non-expansion population, and across states that adopted Medicaid expansion versus those electing not to do so.
5-Slide Series
This edition presents our tabulations on an “average family’s” federal, state and local taxes for CY2018 and how their tax contributions are spent.
Publication
The Menges Group was asked to update an analysis of New York’s Medicaid prescription drug expenditure growth over the past several state fiscal years (SFY). Based on our analysis of year-over-year trends since SFY2014, we anticipate that single-digit annual growth is most likely to occur in the upcoming year. This is also in alignment with CMS nationwide estimates of Medicaid prescription drug expenditure trends.
