Publication
This study examined 35 states and DC that used the Managed Care Organization (MCO) model in their Medicaid program and either included (carved-in) or excluded (carved-out) pharmacy benefits from coverage. The report found that carve-in states outperform carve-out states by a wide margin, saving Medicaid $2.06 billion in state and federal expenditures in 2014 alone.
Key findings of the report include:
Across 28 states using the carve-in model, the net cost per prescription was 14.6% lower than the average net cost per prescription in states not carving in pharmacy.
This 14.6% differential created a $2.06 billion net savings in state and federal expenditures in FFY2014 for states deploying the carve-in model.
The seven carve-out states had a 20% increase in net costs per prescription from FFY2011-FFY2014 — in stark contrast to the 1% increase in net costs per prescription experienced by the 6 states that recently switched from a carve-out to a carve-in model.
The seven carve-out states “missed” a total of $307 million in savings in FFY2014 which would have occurred had they used a carve-in model.
5-Slide Series
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.
5-Slide Series
This edition of our Five Slide Series is focused on honoring accountability in Medicare and Medicaid — where it is being achieved and where it isn’t.
5-Slide Series
This edition of our Five Slide Series is Medicare-focused, policy-oriented, and qualitative and opinionated in nature. We report on the achievements the Medicaid program has made in the mandatory enrollment MCO model, and convey our thoughts on testing a similar approach in Medicare.
5-Slide Series
This edition of our Five Slide Series focuses quantitatively on Medicaid’s “footprint” in terms of the proportion of the country’s population served by the program by age, gender, and race. Our finding agree with the national consensus; Medicaid plays a disproportionately large role in covering our youngest residents, women, and many minority subgroups.
5-Slide Series
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.
5-Slide Series
This edition assesses the 2014 NCQA Medicaid MCO quality scores. Analysis includes calculation of statewide average scores for all plans, top performing MCOs relative to their state’s average, comparisons by ownership (such as publicly traded versus non-publicly traded MCOs), and trends for scores from 2013-2014.
5-Slide Series
This edition looks at Medicaid eligibility trends, including stability in Medicaid coverage. We also find States with managed care tend to offer more stable Medicaid than FFS States.
5-Slide Series
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).
5-Slide Series
This month’s edition provides data on the costs of Medicaid-covered adults and a conceptual framework for estimating the Medicaid expansion population’s emerging PMPM costs.
