Utilization and Spending Trends in Medicaid Outpatient Prescription Drugs, 2015-2019

Appendix A: Tables

Table A1: Top 10 Drug Groups by Prescriptions
Rank 2015 2016 2017 2018 2019
1 Analgesics/ Antipyretics (86,082,409) Analgesics/ Antipyretics (90,170,824) Analgesics/ Antipyretics (87,603,296) Analgesics/ Antipyretics (79,869,640) Analgesics/ Antipyretics (76,321,204)
2 Psychotherapeutic Agents (63,323,593) Psychotherapeutic Agents (68,986,100) Psychotherapeutic Agents (73,151,398) Psychotherapeutic Agents (73,344,877) Psychotherapeutic Agents (74,095,484)
3
Antibiotics
(48,116,460)
Cardiac Drugs (52,973,438) Cardiac Drugs (54,803,664) Cardiac Drugs (53,439,953) Cardiac Drugs (51,222,781)
4 Cardiac Drugs (47,945,551) Antibiotics (49,851,747) Antibiotics (49,680,272) Antibiotics (46,379,522) Antibiotics (45,651,425)
5 Anticonvulsants (32,063,688) Anticonvulsants (35,343,240) Anticonvulsants (37,403,568) Anticonvulsants (36,626,167) Anticonvulsants (35,988,061)
6 Allergy Immunotherapy & Antihistamines (28,486,952) Allergy Immunotherapy & Antihistamines (30,544,135) Antidiabetic Agents (31,258,870) Antidiabetic Agents (30,908,637) Antidiabetic Agents (30,704,265)
7 Sympathomimetic Agents (26,357,905) Antidiabetic Agents (29,755,936) Allergy Immunotherapy & Antihistamines (30,975,968) Allergy Immunotherapy & Antihistamines (29,799,083) Allergy Immunotherapy & Antihistamines (30,083,207)
8 Antidiabetic Agents (26,186,260) Sympathomimetic Agents (27,487,892) Sympathomimetic Agents (27,965,076) Sympathomimetic Agents (27,234,648) Sympathomimetic Agents (26,686,231)
9 Adrenals & Comb. (24,081,529) Adrenals & Comb. (25,998,790) Adrenals & Comb. (26,753,411) Adrenals & Comb. (25,734,924) Adrenals & Comb. (25,814,435)
10 Anxiolytic (23,216,218) Anxiolytic (24,351,405) Antihyperlipidemic Drugs (24,292,645) Antihyperlipidemic Drugs (24,004,351) Antihyperlipidemic Drugs (23,483,226)
SOURCES: KFF analysis of 2015-2019 State Drug Utilization Data; IBM Micromedex RED BOOK, December 2020.
Table A2: Top 10 Drug Groups by Medicaid Paid Amount
Rank 2015 2016 2017 2018 2019
1 Antivirals ($7,848,368,982) Antivirals ($9,206,505,141) Antivirals ($8,917,155,503) Antivirals ($7,457,676,103) Antivirals ($7,853,471,067)
2 Psychotherapeutic Agents ($6,912,012,885) Psychotherapeutic Agents ($6,283,181,304) Antidiabetic Agents ($6,239,455,084) Antidiabetic Agents ($6,308,551,082) Antidiabetic Agents ($6,908,757,194)
3 Antidiabetic Agents ($4,528,901,818) Antidiabetic Agents ($5,668,623,740) Psychotherapeutic Agents ($5,689,022,416) Psychotherapeutic Agents ($5,625,902,994) Psychotherapeutic Agents ($5,873,827,270)
4 Stimulant ($2,987,804,886) Stimulant ($3,170,230,462) Immunosuppressants ($3,918,023,261) Immunosuppressants ($4,601,953,316) Immunosuppressants ($5,866,587,687)
5 Adrenals & Comb. ($2,700,067,098) Immunosuppressants ($3,157,553,958) Stimulant ($3,189,477,837) Stimulant ($3,049,867,394)
Molecular Targeted Therapy ($3,537,105,418)
6 Analgesics/ Antipyretics ($2,453,327,623) Adrenals & Comb. ($2,979,009,890) Adrenals & Comb. ($3,039,048,140) Molecular Targeted Therapy ($2,892,308,999) Adrenals & Comb. ($2,976,007,562)
7 Immunosuppressants ($2,166,612,165) Analgesics/ Antipyretics ($2,502,808,801) Molecular Targeted Therapy ($2,539,071,962) Adrenals & Comb. ($2,890,468,521) Stimulant ($2,934,419,541)
8 Anticonvulsants ($1,947,754,343) Anticonvulsants ($2,175,883,747) Analgesics/ Antipyretics ($2,404,774,675) Anticonvulsants ($2,433,696,422) Coagulants & Anticoagulants ($2,590,002,985)
9 Coagulants & Anticoagulants ($1,798,452,692)
Molecular Targeted Therapy
($2,077,065,490)
Anticonvulsants ($2,330,799,364) Coagulants & Anticoagulants ($2,241,068,696) Analgesics/ Antipyretics ($2,444,551,383)
10 Sympathomimetic Agents ($1,635,996,791) Coagulants & Anticoagulants ($2,013,718,601) Coagulants & Anticoagulants ($2,124,605,146) Analgesics/ Antipyretics ($2,193,543,762) Anticonvulsants ($2,432,123,911)
NOTE: Spending amounts do not include rebates.
SOURCES: KFF analysis of 2015-2019 State Drug Utilization Data; IBM Micromedex RED BOOK, December 2020.

Appendix B: Methodology

This analysis of Medicaid prescription drug utilization and spending trends used 2015 through 2019 State Drug Utilization Data (SDUD), downloaded in early January 2021, merged with data from IBM Micromedex RED BOOK. The SDUD is publicly available data provided as part of the Medicaid Drug Rebate Program. It provides data on the number of prescriptions, Medicaid spending before rebates, and cost-sharing for rebate-eligible Medicaid outpatient drugs. At the time of download, 2019 data were the most recent full year of data available. The RED BOOK data is from December 2020. The use of RED BOOK data does not represent and should not be characterized as a RED BOOK endorsement of any data, findings, or other content presented in this report.

The SDUD and the RED BOOK data were merged at the NDC-level to consistently identify the drug name, as well as to incorporate brand versus generic status and the therapeutic/pharmacologic category of the product. Branded-generic drugs were classified as generic drugs. Using the FDA’s Purple Book, a list of all FDA-licensed biological products regulated by the Center for Drug Evaluation and Research (CDER) and the Center for Biologics Evaluation and Research (CBER) as of December 2020, biological products in the SDUD were identified based on drug name.

Limitations

The SDUD provides spending and utilization data by NDC, quarter, managed care or fee-for-service, and state. It also provides this data summarized for the whole country. CMS has suppressed data cells with fewer than 11 prescriptions, citing the Federal Privacy Act and the HIPAA Privacy Rule. This analysis used the national data because less data is suppressed at the national versus state level.

This analysis does not include rebates because rebate data is unavailable to the public at the NDC level. Rebates have a considerable effect on Medicaid drug spending overall, lowering net spending, but this effect varies at the drug level as different drugs receive different rebates. Additionally, although Medicaid beneficiaries largely self-administer drugs that are prescribed in an outpatient setting, medical practitioners must administer some drugs. Although states are instructed to collect drug rebates on physician-administered outpatient drugs that are not billed as a bundled service, physician-administered drugs subject to a rebate can vary from state to state. Because biologics and other specialty drugs are often physician-administered, it is possible that the data reflects lower Medicaid spending and utilization of certain drugs of this kind.

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