Medicaid Pharmacy Benefit Use and Reimbursement - Introduction and Chartbooks

Introduction

Under a research contract with CMS, Mathematica, Inc. produced a series of research products related to pharmacy benefit use and reimbursement in Medicaid.  Mathematica used the Medicaid Analytic eXtract (MAX) data files for calendar year 1999 and later years for these research products.  The MAX files are constructed from claims and eligibility data that states submit to CMS electronically through the former Medicaid Statistical Information System (MSIS), now the Transformed Medicaid Statistical Information System (T-MSIS).

Mathematica, under the direction of CMS, produced the Statistical Compendium:  Medicaid Pharmacy Benefit Use and Reimbursement (hereafter “the Compendium”) for calendar years 1999 and 2001-2009.

Using the detailed data from the Compendium, Mathematica  prepared Chartbooks for 1999 and 2001-2009.  The Chartbooks present selected highlights from the Compendium and include comparisons across states.  The 2001-2009 Chartbooks also include comparisons to earlier years.
The Chartbook for 2009 do not include eight states (Hawaii, Idaho, Maine, Missouri, New Hampshire, Oklahoma, Utah, and Wisconsin) because their Medicaid Statistical Information System (MSIS) files were unavailable or contained significant data problems.  These eight states accounted for approximately 7 percent of total Medicaid enrollment in 2009.

The Chartbooks are available below.

Medicare Coverage of Prescription Drugs for Dual Eligibles in 2006 and Later Years

The Chartbooks for 2006-2009 illustrate the effects of the shift of most prescription drug coverage for beneficiaries dually eligible for Medicaid and Medicare to Medicare Part D beginning January 1, 2006. As a result of this shift in coverage responsibility, Medicaid expenditures for prescription drugs for dual eligibles dropped from $21.85 billion in 2005 to $1.59 billion in 2006, $1.26 billion in 2007, $1.24 billion in 2008, and $1.02 billion in 2009, and total Medicaid expenditures for prescription drugs for all beneficiaries dropped from $40.19 billion in 2005 to $20.03 billion in 2006, rising to $20.53 billion in 2007, $22.51 billion in 2008, and $22.54 billion in 2009.

CHARTBOOKS

The Chartbooks for 2001 (PDF) and 2002 (PDF) contain 37 tables, charts, and graphs that present highlights from the Statistical Compendiums, including comparisons of use and reimbursement for major eligibility groups (aged, disabled, adults, children, dual eligibles) and types of drugs, and state rankings on key measures.  The 2003 (PDF), 2004 (PDF), 2005 (PDF), 2006 (PDF) and 2007 (PDF) Chartbooks contain 54 tables, charts, and graphs, since a number of additional graphs were added to show trends from 1999 to 2007.  The 2008 (PDF) and 2009 (PDF) Chartbooks contain three additional graphs (Exhibits 55-57) that show comprehensive managed care penetration rates for nondual aged/disabled and adult/children beneficiaries, and for dual eligible beneficiaries. The Chartbook for 1999 (PDF) contains fewer tables.

ISSUE BRIEF

“Trends and Patterns in the Use of Prescription Drugs Among Medicaid Beneficiaries: 1999 to 2009 (PDF)” highlights the changes in volume of drugs used per person, changes in drug costs per person, and changes in the use of generic drugs between 1999 and 2009.  The analysis focuses in particular on drug use and costs for beneficiaries with disabilities and chronic illnesses, whose drug use is much more extensive than that of children and nondisabled adults.  It also focuses on some specific types of drugs that are especially costly for Medicaid:  antipsychotics, antiasthmatics, ulcer drugs, antidiabetics, and antidepressants.

DESCRIPTION OF EXHIBITS

A number of exhibits were created to supplement the information from the Compendiums and found in the Chartbooks. They are available below.  Here is a brief description of the exhibits:

• Exhibit 1 (PDF):  Inclusions and Exclusions from the Study Population, 2001
• Exhibit 2 (PDF):  Beneficiary Characteristics, 2001
• Exhibit 3 (PDF):  Illustrative Measures of Pharmacy Benefit Use and Reimbursement, 2001
• Exhibit 4 (PDF):  Inclusions and Exclusions from the Study Population, 2002
• Exhibit 5 (PDF):  Beneficiary Characteristics, 2002
• Exhibit 6 (PDF):  Illustrative Measures of Pharmacy Benefit Use and Reimbursement, 2002
• Exhibit 7 (PDF):  Inclusions and Exclusions from the Study Population, 2003
• Exhibit 8 (PDF):  Beneficiary Characteristics, 2003
• Exhibit 9 (PDF):  Illustrative Measures of Pharmacy Benefit Use and Reimbursement, 2003
• Exhibit 10 (PDF):  Inclusions and Exclusions from the Study Population, 2004
• Exhibit 11 (PDF):  Beneficiary Characteristics, 2004
• Exhibit 12 (PDF):  Illustrative Measures of Pharmacy Benefit Use and Reimbursement, 2004
• Exhibit 13 (PDF):  Inclusions and Exclusions from the Study Population, 2005
• Exhibit 14 (PDF):  Beneficiary Characteristics, 2005
• Exhibit 15 (PDF):  Illustrative Measures of Pharmacy Benefit Use and Reimbursement, 2005
• Exhibit 16 (PDF):  Inclusions and Exclusions from the Study Population, 2006
• Exhibit 17 (PDF):  Beneficiary Characteristics, 2006
• Exhibit 18 (PDF):  Illustrative Measures of Pharmacy Benefit Use and Reimbursement, 2006
• Exhibit 19 (PDF): Inclusions and Exclusions from the Study Population, 2007
• Exhibit 20 (PDF): Beneficiary Characteristics, 2007
• Exhibit 21 (PDF): Illustrative Measures of Pharmacy Benefit Use and Reimbursement, 2007
• Exhibit 22 (PDF):  Inclusions and Exclusions from the Study Population, 2008
• Exhibit 23 (PDF):  Beneficiary Characteristics, 2008
• Exhibit 24 (PDF):  Illustrative Measures of Pharmacy Benefit Use and Reimbursement, 2008
• Exhibit 25 (PDF):  Inclusions and Exclusions from the Study Population, 2009
• Exhibit 26 (PDF):  Beneficiary Characteristics, 2009
• Exhibit 27 (PDF):  Illustrative Measures of Pharmacy Benefit Use and Reimbursement, 2009