Medicaid Plans - Drug Trend Report


Keeping care affordable for the most vulnerable

In 2016, Medicaid health plans held the increase in drug spending to just 5.5%. While we saw decreases in specialty medication usage – primarily driven by significant decreases in HIV and hepatitis C medication utilization – we continue to see unit cost increase, both in traditional and specialty therapy classes.

Opioids continue to generate significant focus. Despite programs put in place to help curb opioid abuse within the Medicaid population, the pain/inflammation therapy class remains the 7th highest therapy class for Medicaid.

Additionally, there is always room for improved management in the main Medicaid disease states of diabetes, asthma, and mental/neurological disorders.

As we await impending changes to the Medicaid program – whether through the Medicaid Mega Rule or through the use of per capita caps or block grants – diligence in managing the pharmacy benefit is our primary concern. Now more than ever, it’s important for Medicaid plans to focus on effective utilization management and innovative solutions to dealing with common problems like adherence, refilling medications on time and utilizing the most appropriate and cost effective care settings. We are committed to working together to help solve your toughest challenges.

We know our Medicaid health plans count on us for creative solutions to help manage the pharmacy benefit and we eagerly accept the challenge.

Read our full report to learn more about Medicaid prescription drug spending in 2016.

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