5-Slide Series
This edition examines the impact of Medicaid Expansion on prescription drug access, comparing prescription volume trends in 18 states that expanded Medicaid in 2014 with six non-expansion states. We look at overall prescription volume as well as three specific therapeutic classes of drugs: antidepressants, insulin, and bronchodilators.
Over the 10-year timeframe 2014-2023, we estimate that Medicaid Expansion led to nearly 1.2 billion additional prescriptions across the 18 states, representing a 56% increase in overall Medicaid prescription volume. In 2023, the pre-rebate cost per Medicaid prescription averaged $136, or over $1,600 annually per medication. Given the cost and the fact that over 80% of new Expansion enrollees were previously uninsured (and all had low income), these medications would largely have been inaccessible/unaffordable without Medicaid Expansion.
Publication
Utah’s Medicaid program contracts with four Accountable Care Organizations (ACOs) to coordinate care for most of the state’s Medicaid enrollees. This October 2024 report examines the fiscal and programmatic impacts that transitioning to a prescription drug carve-out model, where the pharmacy benefit would be managed under a single-payer system using the fee-for-service payment methodology, would have on Utah’s Medicaid program. Our key recommendations include preserving the current pharmacy carve-in model, piloting a hybrid Preferred Drug List that allows the Utah Department of Health and Human Services and the ACOs to jointly guide utilization towards the most cost-effective drugs for specified drug classes, and exploring potential revisions to supplemental rebates collection and capitation rates for the pharmacy benefit.
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This report explores the fiscal and programmatic impacts that a switch to a prescription drug carve-out model, where the pharmacy benefit would be managed under a single-payer system within Medicaid using the fee-for-service payment methodology, would have on Virginia’s Medicaid program (Cardinal Care). Our key recommendations for the Medicaid program include preserving the current pharmacy carve-in, preserving the common core formulary (i.e., the preferred drug list), enhancing reimbursements to critical access pharmacies, increasing MCO policymaking representation, and exploring potential revisions to capitation rates for the pharmacy component.
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This report explores which prescription drug model is best suited for Washington’s Apple Health (Medicaid) program: the current carve-in prescription drug model, under which managed care organizations (MCOs) pay for members’ prescriptions, or a carve out model, where prescriptions are managed by a separate company using a fee-for service (FFS) payment mechanism. Our overall recommendation is that Washington should preserve the carve-in pharmacy model for the Medicaid program
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.
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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.
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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.
