Publication
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.
Publication
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.
5-Slide Series
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.
5-Slide Series
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
5-Slide Series
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.
5-Slide Series
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.
5-Slide Series
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.
5-Slide Series
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.
Publication
Over 90 percent of Louisiana’s Medicaid prescriptions are paid for by MCOs. The Louisiana Association of Health Plans engaged us to assess the impacts of a potential policy change to take the preferred drug list (PDL) content responsibility away from the Medicaid MCOs and shift it to a single state-administered and state-determined PDL. Our key finding is that this policy change would be costly to the State and its taxpayers – increasing overall annual Medicaid costs by $40 million and increasing annual State Fund expenditures by approximately $15 million. Our report provides evidence across dozens of states demonstrating that a focus on optimal management of Medicaid’s drug mix at the “front end” produces more favorable net costs than an approach that relies primarily on “back end” rebate maximization.
5-Slide Series
The February report pieces together different data on prescription volume by state – mostly through our staff’s tabulations – showing the distribution of each state’s total 2015 prescriptions between those paid by Medicaid, Medicare Part D, and all other payer sources combined. There was considerable variation in this percentage distribution in each state.
