State Medicaid programs are the nation’s largest buyers of prescription drugs, serving over 50 million Americans, including the most vulnerable and costly patients. However, Medicaid drug benefits are complex and vary from state to state and among the diverse populations served.
We now have an wealth of new information on Medicaid drug spending and utilization, thanks to excellent work by Mathematica Policy Research under a project for the federal Centers for Medicare and Medicaid Services (CMS).
For the first time, CMS is able to provide state-by-state and national data on the use of and reimbursement for prescription drugs in Medicaid. Available free on CMS’ website in both PDF and Excel spreadsheet formats, the data breakdown use and costs by:
– Beneficiary demographic characteristics (age, sex, and race).
– Basis of eligibility (children, adults, disabled, and aged).
– Medicare-Medicaid dual eligible status.
There are detailed tables for all Medicaid beneficiaries combined, plus separate tables for dual eligibles and for full-year residents of nursing facilities. The tables show prescription drug use and spending by:
– Brand status (patented brand name, off-patent brand name, and generic).
– Therapeutic category (cardiovascular agents, central nervous system drugs, etc.).
– Drug group (anti-psychotics, anti-depressants, ulcer drugs, etc.).
Starting in 2006, seven million dual eligibles will receive their drug benefits under the new Medicare Part D program. Prospective Medicare drug plans will find this new information incredibly helpful in understanding the drug needs of this unique population.