5-Slide Series
This edition provides excerpts of opioid-related questions that have appeared in Medicaid MCO procurements. These slides demonstrate some of the ways in which states are using their request for proposal (RFP) process to promote innovation and elevate the MCOs’ mechanisms to effectively serve enrollees who have opioid use disorder.
5-Slide Series
This edition looks at various state-level policy changes seeking to restrict inappropriate use of opioids, conducting a pre-versus-post comparison of prescription opioid usage related to the dates of these policy changes.
5-Slide Series
This edition focuses on the trends in Medicaid prescription opioid and MAT use. An example of our findings is that opioid prescriptions per Medicaid enrollee decreased 54% from 2013-2022.
Publication
This report describes trends in opioid and medication-assisted treatment (MAT) prescription drug usage in Medicaid, put together for a presentation at a recent opioid conference.
Publication
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.
5-Slide Series
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.
5-Slide Series
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.
5-Slide Series
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.
5-Slide Series
We were enlisted by the Anthem Public Policy Institute to assess the cost-effectiveness of different states’ approaches to managing Medicaid prescription drug benefit. States were grouped into five cohorts depending on the degree to which their Medicaid prescriptions are paid for by MCOs or via the fee-for-service (FFS) setting – and by the degree of latitude MCOs have to manage the mix of drugs. We assessed 100% of Medicaid prescriptions across federal fiscal years 2018, 2019, and 2020.
Publication
States that employ Medicaid managed care organizations (MCOs) to pay for prescription drugs outperform states that rely on the fee-for-service (FFS) setting to control drug costs. Despite larger rebates in FFS, MCOs’ effective strategies to encourage…
