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Tag: Medicaid

Medicaid MCO-Provider Price Negotiations

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…

Dec. 1, 2015 Download 5 slide

KEYWORDS:Medicaid

Projected Savings of Medicaid Capitated Care: National and State-by-State

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…

Nov. 12, 2015 Download Full Report

ADDITIONAL RESOURCES:

Press Release

KEYWORDS:Expenditures, Medicaid

Progression of Medicaid Costs and Usage of Selected Hepatitis C Medications: Sovaldi, Harvoni, and ViekiraPak

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…

Nov. 1, 2015 Download 5 slide

KEYWORDS:Expenditures, Medicaid, Prescription Drugs

Medicaid Expansion – Enrollment Stream From January 2014 Forward

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.

Oct. 1, 2015 Download 5 slide

KEYWORDS:Enrollment, Expansion, Medicaid

Use of Medicaid MCO Capitation by State – Projections for 2016

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…

Sep. 30, 2015 Download 5 slide

KEYWORDS:Expenditures, Medicaid

Medicaid Cost Per Prescription Differences Between States

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;…

Jul. 24, 2015 Download 5 slide

KEYWORDS:Expenditures, Medicaid, Prescription Drugs

Medicaid Pharmacy Carve-In and Carve-Out Dynamics

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…

Jun. 16, 2015 Download 5 slide

KEYWORDS:Medicaid, Pharmacy Carve Out, Prescription Drugs

Specialty Pharmacy’s Growing Role in Medicaid

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%…

May. 29, 2015 Download 5 slide

KEYWORDS:Expenditures, Medicaid, Prescription Drugs

Medicaid Data on Sovaldi, Harvoni and Kalydeco

The April 2015 edition presents recent nationwide and state-level data on Sovalidi usage. These slides also convey recent usage of a related Hepatitis C medication (Harvoni) as well as a specialty pharmacy drug, Kalydeco, in a completely different clinical area…

Apr. 30, 2015 Download 5 slide

KEYWORDS:Medicaid, Prescription Drugs

Comparison of Medicaid Pharmacy Costs and Usage in Carve-In Versus Carve-Out States

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…

Apr. 16, 2015 Download Full Report

KEYWORDS:Medicaid, Pharmacy Carve Out, Policy, Prescription Drugs