The Menges Group was asked to update an analysis of New York’s Medicaid prescription drug expenditure growth over the past several state fiscal years (SFY). Based on our analysis of year-over-year trends since SFY2014, we anticipate that single-digit annual growth is most likely to occur in the upcoming year. This is also in alignment with CMS nationwide estimates of Medicaid prescription drug expenditure trends.
The September edition presents Medicaid data from our Pharmacy Practice, quantifying the differences in cost per prescription between the MCO and FFS settings in two selected high-volume therapeutic classes. In both drug classes (as occurs with Medicaid prescriptions overall), the MCO setting is achieving large percentage savings relative to FFS. However, the path taken to achieve these savings is quite different between the two drug classes shown.
Legislation has been proposed in Louisiana to take the Medicaid preferred drug list (PDL) content responsibility away from the MCOs and shift it to a single state-determined PDL. The Menges Group assessed the impact of this policy option and estimated by transitioning to a PDL, Louisiana would experience a 13.5% increase in Medicaid pharmacy expenditures, with State Fund costs growing by $23 million in FFY2019 and $121 million across the five-year timeframe FFY2019-FFY2023. The non-financial programmatic dynamics of MCO latitude relative to a uniform Medicaid PDL are also discussed.
Currently, Louisiana includes (carves in) the pharmacy benefit in its capitated contracts with Medicaid MCOs. During FFY2017, Louisiana had the nation’s most favorable Medicaid generic dispensing rate at 90.9% and the nation’s 8th best (lowest) cost per prescription. The Menges Group analyzed the impact of legislation proposing a carve-out of the prescription drug benefit. Based on our analysis, transitioning the Medicaid prescription drug benefit back to fee-for-service would be costly for the Medicaid program and Louisiana’s taxpayers. We estimate that Louisiana would experience a State Fund cost increase of $69.3 million in FFY2019 and $395 million across the five-year timeframe FFY2019-FFY2023. Our report also discusses the programmatic advantages of preserving the pharmacy carve-in model.
The March 2018 edition of our 5 Slide Series tracks the national Medicaid market share and pre-rebate cost per prescription progression of curative Hepatitis C drugs from CY2014 through CY2017. The introduction of newer, lower cost-per-unit drugs has resulted in a significant shift in market share within this category of drugs. Additionally, we have quantified the considerable market share differences between MCO-paid and FFS-paid Medicaid prescriptions.
The May edition conveys the rapidly growing percentage of Medicaid prescriptions paid by managed care organizations (MCOs), and shows this progression in each state from 2013 through 2016
The January edition tabulates the distribution of Medicaid pharmacy costs by unit price cohort. Explosive growth in the share of Medicaid prescriptions among drugs costing more than $1,000 per prescription (pre-rebate) continues to occur. These drugs now represent 40% of all Medicaid pre-rebate prescription drug expenditures.
The December Edition of the Series tabulates nationwide Medicaid prescription drug information from the beginning of 2015 through mid-2016. Some of the key findings are that Medicaid MCOs now pay for more than two-thirds of all Medicaid prescriptions, and that generics accounted for 81% of all Medicaid prescriptions but only 20% of Medicaid pre-rebate Rx expenditures during Q2 2016.
Our October edition focuses on prescription drugs, tracking Medicaid’s nationwide unit price progression from 2013-2016 for each of the 25 NDCs generating the largest Medicaid expenditures. The average annual price increases across these 25 drugs was 10% (mean) and 8% (median), led by a more than doubling (133% overall increase) of the price of Epipen 2-Pak across the timeframe assessed.
This month’s edition investigates prescription drug spending in all 50 states across three major state health care payers: Medicaid, state employee health plans, and in state prisons. By comparing these expenditures to total health care spending and overall spending in each state, one gets a better idea of the relative extent of state spending on prescription drugs.