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New Poll: Voters Want to Reduce Wasteful Spending in Medicaid Pharmacy
Date:12/10/2010

ayers, Medicaid MCOs, or health plans in the commercial sector.
  • Ingredient Costs: The rate at which retail pharmacies are reimbursed for the actual medication ingredients (pills, capsules, etc.) is also higher, on average, in Medicaid FFS programs than in Medicare Part D or the commercial sector.
  • Drug Utilization: The number of prescriptions dispensed per person is typically higher in Medicaid FFS programs than in Medicaid MCOs due to less effective controls on polypharmacy, fraud, waste, abuse, and other factors in the FFS setting.

  • Estimated Federal and State Medicaid Savings

    If all state Medicaid programs used a market-based approach such that dispensing fees, ingredient costs, drug utilization, and generic drug dispensing were brought in-line with norms for Medicaid MCOs, Medicare Part D, and commercial payers, Lewin estimates that:

    • Combined federal and state savings to the Medicaid program would total $30.3 billion over the next decade.
    • Medicaid FFS prescription costs could be reduced by 14.8%.
    • Per member per month (PMPM) costs for Medicaid FFS pharmacy benefits could be reduced by $12 in 2011 under optimal management.

    PCMA represents the nation's pharmacy benefit managers (PBMs), which improve affordability and quality of care through the use of electronic prescribing (e-prescribing), generic alternatives, mail-service pharmacies, and other innovative tools for 200-plus million Americans.


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    SOURCE Pharmaceutical Care Management Association
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