posted by Clare Krusing
on April 1, 2015
For Immediate Release
Washington, D.C. – States in which Medicaid plans manage prescription drug benefits are realizing large-scale savings, according to a new analysis by The Menges Group.
The study, “Comparison of Medicaid Pharmacy Costs and Usage in Carve-In Versus Carve-Out States,” examined 35 states and DC that used the Managed Care Organization (MCO) model in their Medicaid program and either included (carved-in) or excluded (carved-out) pharmacy benefits from coverage. The report found that carve-in states outperform carve-out states by a wide margin, saving Medicaid $2.06 billion in state and federal expenditures in 2014 alone.
With regard to significant cost savings in carve-in states, and in light of their better coordination of services, the authors conclude: “Our findings suggest that states that maintain prescription drugs as part of the MCO benefit are able to achieve cost savings while at the same time provide highly integrated care. The pharmacy carve-in model appears to resoundingly fulfill both objectives.”
Key findings of the report include:
“Medicaid plans’ ability to provide coordinated care through pharmacy benefits is crucial for beneficiaries and critical to protecting taxpayers and state budgets,” said America’s Health Insurance Plans President and CEO Karen Ignagni. “Allowing health plans to coordinate health and pharmacy benefits is essential for improving and maintaining the health of Medicaid beneficiaries and protecting limited state resources.”
To view the full analysis, click here.
For more information on how carving pharmacy into Medicaid managed care organization (MCO) benefits is critical for beneficiary outcomes, click here.
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