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Tag: Prescription Drugs

5-Slide Series

Medicaid Pharmacy Costs and Usage Trends

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This edition provides data on Medicaid prescription drug usage and costs and trends from 2013 to 2015. Each data table shows national totals and subtotals for three groups of states: non-expansion states, initial Medicaid expansion states (those implementing Medicaid expansion in January 2014), and subsequent expansion states. The tables show all Medicaid-paid pharmacy volume, including prescriptions paid by Medicaid MCOs and those paid in the Medicaid fee-for-service setting. Tables differentiate pre-rebate and post-rebate spending.

5-Slide Series

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

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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 exploded in popularity over that span, despite the high prices they command. In this slide deck we look at these drugs on a state-by-state basis, as well as on the national level.

5-Slide Series

Medicaid Cost Per Prescription Differences Between States

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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; rebates averaged $35 per prescription. Net costs per prescription at the state level ranged from a low of $24 in Rhode Island to a high of $60 in Connecticut.

5-Slide Series

Medicaid Pharmacy Carve-In and Carve-Out Dynamics

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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 the pharmacy carve-in model.

5-Slide Series

Specialty Pharmacy’s Growing Role in Medicaid

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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% of pre-rebate Medicaid pharmacy spending in 2005 but have increased to 28.4% of Medicaid pharmacy spending in 2013 and 32.6% of Medicaid pharmacy spending in 2014.

5-Slide Series

Medicaid Data on Sovaldi, Harvoni and Kalydeco

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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 for comparison purposes.

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

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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 a wide margin, saving Medicaid $2.06 billion in state and federal expenditures in 2014 alone.

Key findings of the report include:
Across 28 states using the carve-in model, the net cost per prescription was 14.6% lower than the average net cost per prescription in states not carving in pharmacy.

This 14.6% differential created a $2.06 billion net savings in state and federal expenditures in FFY2014 for states deploying the carve-in model.
The seven carve-out states had a 20% increase in net costs per prescription from FFY2011-FFY2014 — in stark contrast to the 1% increase in net costs per prescription experienced by the 6 states that recently switched from a carve-out to a carve-in model.
The seven carve-out states “missed” a total of $307 million in savings in FFY2014 which would have occurred had they used a carve-in model.

5-Slide Series

Medicaid Pharmacy Rebates

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This report summarizes Medicaid’s pharmacy costs during 2013 and 2014 and demonstrates the importance of viewing these expenditures on a net, post-rebate basis. Rebates accounted for 48.5% of the initial amount paid to pharmacies for Medicaid prescriptions during 2014, for example. The report also conveys the usage and cost information that is publicly available to date for Sovaldi.

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Prescription Drug Adherence in Medicaid Managed Care

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Prescriptions for a Healthy America (P4HA) released a report by the Menges Group examining how Medicaid Managed Care Organizations (MCOs) are combatting prescription drug nonadherence.

The report highlights the efforts of several Medicaid plans and their best practices for improving prescription drug adherence

In commenting on the report’s release, Joel White, President of Prescriptions for a Healthy America made the following statement: “We believe this report is another important contribution to the growing body of evidence that finds medication adherence saves money and improves health. What’s particularly exciting are the strategies outlined in the report can be adopted, today, by Governors across the country as they seek to improve Medicaid in ways that improve patient health, lower health costs and make the health system work better for everyday Americans. We encourage Governors to take notice.”

The report’s lead author, Joel Menges, noted that: “While a large segment of the Medicaid population takes medication daily, the poverty population’s life circumstances can diminish adherence in many ways. The supportive innovations occurring in this arena are of benefit to all stakeholders.”

5-Slide Series

Eliminating Excess Costs and Redeploying Savings

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These slides are health policy focused, looking at areas where significant cost savings can/should occur, and identifying at a high level ways that these savings can best be redirected to improve overall health. Some of these concepts are relevant to current Sovaldi discussions, although the “value pricing” issue has much broader reach.

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