Report Paints Comprehensive Picture of Medicaid Trends

Specialty pharmacies do a fair amount of business with Medicaid. In many states the Medicaid program allows any willing provider access, sometimes across state lines. The downside is that reimbursement margins may be very thin for the pharmacy. None the less, one element of sustaining any business is cash flow. Even with thin margins, Medicaid sales can be a reliable cash flow generator. As such, keeping an eye on trends in the Medicaid universe is a prudent business practice.

Magellan Rx recently published a nifty analysis for your reading pleasure. It details trends over the past few years. Knowing where the trends are heading can help with allocating resources to build new referral relationships, tweak operational / service planning, and more. The report also includes a bunch of useful charts and graphs.

Key 2020 findings include:

  • In 2020, specialty drugs accounted for 51.4% of the net cost in Medicaid
  • Specialty drugs only accounted for 1.3% of utilization.
  • Traditional net cost trend for Medicaid FFS was positive for the first time in five years driven by new-to-market drugs.
  • Medicaid FFS top drug classes remained almost identical to previous years
  • HIV/AIDS and antipsychotics accounting for more than 19.8% of the total net drug spend.
  • Most key conditions will experience increased trend over the next three years. 
  • Conditions with generic drug introductions or specialized management strategies will trend lower.
  • The 2020 virus impacted patient continuity of care triggering technology-based solutions (e.g., video conferencing, shift to home care, and more).

CLICK HERE to access the full Magellan report.

Long Predicted Medicaid Specialty Drug Trend Finally Surpasses 50% of Pharmacy Spend in the Latest Magellan Rx Management Medicaid Pharmacy Trend Report

November 15, 2021  — PHOENIX–(BUSINESS WIRE)– Magellan Rx Management, the full-service pharmacy benefits management division of Magellan Health, Inc. (NASDAQ: MGLN), released its sixth annual Medicaid Pharmacy Trend ReportTM, the industry’s leading report exclusively detailing trends in the Medicaid pharmacy fee-for-service (FFS) space.

The Medicaid Pharmacy Trend Report highlights the evolving landscape of Medicaid, made even more dynamic from the events of the last two years. The report includes an in-depth analysis of class and drug trends, forecasting of Medicaid key conditions, drugs in the pipeline, and Medicaid pharmacy economics. This is also the only detailed industry source for the analysis of Medicaid pharmacy fee-for-service (FFS) gross, net, and forecasted drug cost trends.

“As our nation continues to navigate the lasting impacts of the COVID-19 pandemic, there is no doubt that states are facing unprecedented challenges across all areas of government, especially related to ensuring the mental and physical well-being of their citizens,” said Meredith Delk, PhD, MSW, general manager and senior vice president, government markets, Magellan Rx Management. “The Medicaid Trend Report illustrates critical data-driven observations and solutions. The valuable insights in this report can assist states on their mission to ensure a high quality and cost-effective prescription drug program for their most vulnerable populations.”

“Our ability to offer comprehensive and configurable solutions that fundamentally connect the dots for our customers and their members around the efficacy of drugs, quality care and payments is key,” said Delk.

The Magellan Rx Management Medicaid Pharmacy Trend Report includes data from Magellan Rx’s Medicaid FFS pharmacy programs in 25 states and the District of Columbia. The material is reviewed and supported by a team of Magellan Rx experts with broad national expertise, including 369 years of combined pharmacy benefit administration (PBA) experience.


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