The study, which is based on analysis of
"There is a real budgetary opportunity for federal and state policymakers to reduce costs while making
According to the new research, using the full range of PBM tools and strategies in state
Click here to read the study.
Components of these potential savings include:
$26.5 billionsaved by optimizing the use of generic drugs: Generics are typically (but not always) the lowest net cost products for state Medicaidprograms. In aggregate, each percentage point increase in the generic dispensing rate yields roughly a 3% reduction in net prescription drug costs. $2.4 billionsaved by encouraging the use of more affordable, preferred brands: State Medicaidprograms that continue the antiquated practice of exempting entire classes of drugs from Preferred Drug List reviews make it more difficult to use Prior Authorization (PA) protocols that encourage both safe and cost-effective drug utilization. $1.9 billioncould be saved over the next ten years in reduced drug diversion, polypharmacy, fraud, and waste: Medicaidplans that are more actively managed detect patterns of fraud through use of tools like step therapy, audits, and pharmacy lock-in programs to help detect and avoid inappropriate utilization.
- By using a competitive process and negotiating better discounts from drugstores that wish to participate in more selective pharmacy networks,
Medicaidcould save $11.4 billionover the next ten years. State Medicaidprograms could achieve greater savings by implementing competitive pharmacy contracting processes that characterize Medicare Part Dand commercial-sector programs. In Medicare Part D, preferred pharmacy options have demonstrated savings of 6.1%. $9 billionsaved by aligning pharmacy reimbursements with competitive levels in the commercial sector: CMS has recently required that states adopt an Actual Acquisition Cost (AAC) methodology for paying pharmacies. The AAC approach may result in higher pharmacy reimbursements than the already higher-than-average reimbursements characteristic of traditional Medicaidprograms.
PCMA is the national association representing America's pharmacy benefit managers (PBMs). PBMs administer prescription drug plans for more than 266 million Americans who have health insurance from a variety of sponsors including: commercial health plans, self-insured employer plans, union plans,
To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/new-report-greater-adoption-of-pharmacy-cost-saving-tools-in-medicaid-could-save-federal-state-governments-511-billion-over-next-decade-300344394.html