The rebate program reduces net federal and state Medicaid spending on prescription drugs. In 2017, Medicaid spent $64 billion on drugs and got $34.9 billion in rebates from manufacturers. Net spending was $29.1 billion.
Managing the prescription drug benefit and expenditures is a perennial policy priority for state Medicaid programs, in part because policymakers remain concerned about spending growth. We explore key questions about states’ administration of this benefit.
Medicaid payments for prescription drugs are determined by a complex set of policies, at both the federal and state levels, that draw on price benchmarks. Price benchmarks represent prices paid by different parties at different stages in the drug manufacturing, acquisition, and dispensing processes. We explain how it works.
Medicaid is a large source of federal and state spending. Recent audits and improper payment reports have brought program integrity issues to the forefront. We explain what program integrity is, CMS efforts to address it and current and emerging issues.
Tennessee’s proposal to finance its Medicaid program through a “modified block grant” that allows for shared savings could create an incentive for the state to reduce optional eligibility or services for high-cost enrolees so that it can achieve savings.
Key issues to watch in 2020 include: Medicaid expansion developments; Section 1115 waiver activity; enrollment and spending trends; benefits, payment and delivery system reforms, and the implications of the 2020 elections.
As of January 2020, 14 states have not adopted the ACA Medicaid expansion. Across all non-expansion states, 4.4 million uninsured nonelderly adults would become eligible for Medicaid if all opted to expand their programs. Our fact sheets show what’s at stake in each state.
Most (63%) of the 23.5 million adults with Medicaid coverage in the U.S. who are not eligible for both Medicare and Medicaid, and who do not receive federal disability payments, are already working full- or part-time.