Publication
The Texas Association of Health Plans engaged The Menges Group to prepare an analysis of the impacts of switching from a statewide uniform Medicaid prescription formulary to a model that allows Medicaid MCOs flexibility to develop their own preferred drug lists (PDL). Currently, Medicaid MCOs in Texas must utilize a uniform formulary controlled by the state. In this report, we assessed a model in which Medicaid MCOs have the latitude to manage the covered mix of drugs through their own PDLs. We conducted this assessment using multiple analyses, including a cost per prescription analysis, therapeutic class analysis, and quantitative and qualitative survey of Texas MCOs. This approach is estimated to result in total annual Medicaid savings of $236 million and annual general revenue savings of nearly $100 million. For this reason, a policy change towards the PDL latitude model is recommended. In addition to the report, a presentation summarizing the findings can be found in the Executive Summary hyperlink.
5-Slide Series
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.
5-Slide Series
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.
Publication
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.
5-Slide Series
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.
5-Slide Series
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.
5-Slide Series
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.
5-Slide Series
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.
5-Slide Series
The June 2015 edition summarizes a full report we prepared in April, sponsored by America’s Health Insurance Plans. We believe this report, “Comparison of Medicaid Pharmacy Costs and Usage in Carve-In Versus Carve-Out States,” compellingly demonstrates the cost-effectiveness of using the pharmacy carve-in model.
5-Slide Series
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.
