Report Details Trends in Medicaid Fee-for-Service Pharmacy Programs

MHE Publication, MHE November 2019, Volume 29, Issue 11

New report outlines innovative state strategies for managing high-cost Medicaid prescription drugs.

Magellan Rx Management, the full-service pharmacy benefits management division of Magellan Health, Inc., today released its fourth annual Medicaid Pharmacy Trend Report, developed through in-depth data analysis and supported by Magellan’s experience in managing fee-for-service (FFS) Medicaid pharmacy programs.

The report outlines emerging and innovative state strategies for managing high-cost Medicaid prescription drugs. The report also includes a forecast of the top key conditions in Medicaid along with a pipeline analysis of drugs expected to impact the Medicaid program.

Key findings in this year’s report include:

  • Specialty net trend of 6.1%, up slightly over last year, continued to contribute positively to the overall net trend, but is well below the 20.5% net trend seen in 2016.

  • Traditional net trend declined from -5.1% in 2016 to -2.6% in 2018. Even with the negative trend, it is not declining at the same pace as the previous two years.

  • The average net cost per claim was nearly flat at 0.8% change, compared to -4.4% in 2017.

  • Magellan Rx’s new analytics product, MRx Predict, shows the overall gross trend is expected to marginally rise from 2018 as new, groundbreaking therapies and specialty drugs continue to create upward pressure.

Related:Generics of Older Drugs Could Have Saved Medicare Billions, Study Says

“The Medicaid Pharmacy Trend Report is an effective tool in providing states with data and solutions to better manage cost trends and improve budget predictability for their Medicaid FFS pharmacy benefit management program,” says Doug Brown, vice president and chief strategy officer, government markets, Magellan Health. “The report examines drug classes with the largest effect on Medicaid net spend, cost-saving opportunities, and a detailed look at how recent legislative and state program innovation has and will affect the Medicaid program.”