Our Publications

Reports

Assessment of Pennsylvania's Medicaid Preferred Drug List Policy Options
May 2019

Summary

The Pennsylvania Coalition of Medical Assistance MCOs engaged The Menges Group to estimate the fiscal impacts of switching to a uniform PDL in Pennsylvania and to assess the programmatic advantages and disadvantages of this policy change. Our analyses indicate that the Commonwealth of Pennsylvania and its taxpayers would incur significant costs if Pennsylvania adopts a uniform, state-determined Medicaid PDL. The state fund cost of this policy change is estimated at $81 million in the first year (FFY2020) and $442 million across the five-year timeframe FFY2020 – FFY2024. The programmatic dynamics of switching to a uniform PDL are also unfavorable.  We encourage Pennsylvania policymakers to preserve the PDL latitude model within HealthChoices.

Full Report


Assessment of Report on Impacts of West Virginia Medicaid Prescription Drug Carve-Out
Apr 2019

Summary

America’s Health Insurance Plans (AHIP) engaged The Menges Group to assess West Virginia’s Medicaid pharmacy carve-out impacts, analyzing the findings of another consulting firm’s report.  Our analyses suggest that West Virginia’s carve-out has created increased Medicaid expenditures rather than savings.  We also provide a large volume of evidence from states that switched to a carve-in approach (comparing their cost per prescription progression to states that maintained their carve out model).  These results, taking into account all Medicaid pharmacy claims and rebates in 13 states and across a several year comparison timeframe, compellingly indicate that the carve-in model has yielded large-scale savings relative to the carve-out approach. 

Full Report


New York Medicaid Prescription Drug Expenditure Trends
Nov 2018

Summary

The Menges Group was asked to update an analysis of New York’s Medicaid prescription drug expenditure growth over the past several state fiscal years (SFY). Based on our analysis of year-over-year trends since SFY2014, we anticipate that single-digit annual growth is most likely to occur in the upcoming year. This is also in alignment with CMS nationwide estimates of Medicaid prescription drug expenditure trends.

Full Report


Assessment of Louisiana Medicaid's Prescription Drug Management Performance and Preferred Drug List Policy Options
May 2018

Summary

Legislation has been proposed in Louisiana to take the Medicaid preferred drug list (PDL) content responsibility away from the MCOs and shift it to a single state-determined PDL. The Menges Group assessed the impact of this policy option and estimated by transitioning to a PDL, Louisiana would experience a 13.5% increase in Medicaid pharmacy expenditures, with State Fund costs growing by $23 million in FFY2019 and $121 million across the five-year timeframe FFY2019-FFY2023. The non-financial programmatic dynamics of MCO latitude relative to a uniform Medicaid PDL are also discussed.

Executive Summary

Full Report


Assessment of Louisiana Medicaid's Prescription Drug Carve-Out Option
May 2018

Summary

Currently, Louisiana includes (carves in) the pharmacy benefit in its capitated contracts with Medicaid MCOs. During FFY2017, Louisiana had the nation’s most favorable Medicaid generic dispensing rate at 90.9% and the nation’s 8th best (lowest) cost per prescription. The Menges Group analyzed the impact of legislation proposing a carve-out of the prescription drug benefit. Based on our analysis, transitioning the Medicaid prescription drug benefit back to fee-for-service would be costly for the Medicaid program and Louisiana’s taxpayers. We estimate that Louisiana would experience a State Fund cost increase of $69.3 million in FFY2019 and $395 million across the five-year timeframe FFY2019-FFY2023.  Our report also discusses the programmatic advantages of preserving the pharmacy carve-in model.

Executive Summary

Full Report