The Lewin study also finds that although state Medicaid programs pay widely varying Medicaid dispensing fees, these decisions seem largely unrelated to the level of ingredient cost reimbursements a state pays or the level of generic utilization a state achieves. For example, Texas pays the nation's highest dispensing fees ($7.50) and New Hampshire pays the lowest ($1.75), but they both pay about the same for ingredient costs and generate similar rates of generic drug utilization.
Many Medicaid pharmacy discussions begin and end with the issue of the drug manufacturer rebates. However, the statutory and supplemental rebates paid to Medicaid by brand name drug manufacturers are determined separately from pharmacy dispensing fees and ingredient costs. This means that manufacturer rebates have no impact on the savings that more active management of dispensing fees and ingredient costs could achieve. Likewise, these savings also do not assume any additional cost sharing for Medicaid beneficiaries.
Savings Opportunities Exist In Four Key Areas
While Medicaid FFS programs and costs vary greatly state-by-state, The Lewin Group identified four key areas where pharmacy benefit management could generally be improved:
Generic Drug Dispensing: Medicaid FFS is less effective at encouraging the dispensing of generic drugs in place of brands. The generic dispensing rate in Medicaid FFS averages 68%, compared to an average 80% generic dispensing rate in Medicaid MCOs.
·Dispensing Fees: At $4.81 per prescription, the national average dispensing fee that Medicaid FFS programs pay to retail pharmacies per each prescription is more than double the average dispensing fees paid by Medicare Part D payers, Medicaid MCOs, or health plans in the commercial sector.
·Ingredient Costs: The rate at which retail pharmacie
|SOURCE Pharmaceutical Care Management Association|
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