With more than 70 million beneficiaries nationwide, many of whom have complicated health needs, Medicaid is one of the largest providers of prescription drugs in the United States.
Overall, individuals who enroll in Medicaid programs have poorer health than enrollees who purchase private coverage, and they are more likely to require prescription drugs to manage their medical conditions. A recent study from Kaiser Family Foundation identified the 50 most costly drugs before rebates paid for by Medicaid between January 2014 and June 2015.
To determine the 50 costliest drugs in terms of aggregate spending, researchers examined drug utilization data by state (available through CMS) and Wolters Kluwer Clinical Drug Information data.
Below are six findings on Medicaid's costliest drugs.
1. Forty-five of the top 50 drugs were considered high-cost, in part, because they were the most frequently prescribed.
2. More than half (28) were frequently prescribed but not expensive at the prescription level. Among those were hydrocodone-acetaminophen, which was the most frequently prescribed drug in Medicaid during the period studied, and treatments for ADHD.
3. The top five most commonly prescribed drugs in Medicaid were used for pain relief, management of chronic illness and antibiotics.
4. Only five of the top 50 drugs were high-cost drugs with low prescription rates. These included drugs to treat hepatitis C and HIV.
5. Antivirals accounted for 20 percent of the top 50 drugs used by Medicaid.
6. Overall, the most costly drugs used by Medicaid included those to treat behavioral health conditions (Abilify and Vyvanse), hepatitis C (Sovaldi and Harvoni) and HIV (Truvada).