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.
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.
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.
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.”
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.
The Association for Community Affiliated Plans (ACAP) enlisted The Menges Group to prepare a report on the ways in which state Medicaid agencies have opted to regulate Medicaid MCO PDL content. Most states afford MCOs wide latitude in establishing their PDLs. Conversely, a few states require MCOs to use the statewide Medicaid fee-for-service PDL, and a few others have taken a middle ground regulatory position. The paper emphasizes that utilizing the lowest-cost, clinically effective medication is one of the most important avenues available to achieve Medicaid savings, and concludes that wide MCO latitude over PDL content is the most appropriate policy.
This study explores how more efficient pharmacy benefits management—apart from drug manufacturer rebates—could save Medicaid an additional $74.4 billion over the next decade. These savings opportunities are compelling as the federal government and states strive to protect benefits and prepare for the Medicaid expansion authorized by the Affordable Care Act starting in 2014.