Covering weight loss drugs driving Virginia Medicaid costs higher
That cost climbed to
Virginia Medicaid program faces
But when the state
About 13 states cover the medications.
With the federal
The managed care plans that cover most of Virginia Medicaid's patients began reporting significant price increases to Medicaid officials in late spring last year.
The drugs are expensive, and Americans pay more for them than people in other countries do, according to a
Tweedy said the standards for when and how the department pays for the medications is one area where it needs to focus on cost effectiveness and controlling spending growth.
Emergency room care also a factor
Another is emergency room payments.
Medicaid's payments for ER care have increased 15% a year for the past two years, Tweedy said.
The state last year lost a federal court case challenging a longstanding policy toward cutting Medicaid payments to emergency room physicians if a patient came to the ER with a nonemergency, paying instead as if the doctors performed more routine care.
While the
Policymakers and insurers have long tried to rein in claims for unnecessary ER visits, arguing that they are one reason why
One reason why many Medicaid patients may be turning to emergency rooms for treatment is that Medicaid, unlike commercial insurance, does not require the people it covers — basically low-income families and adults as well as people with severe disabilities — to pay for part of the cost out of pocket, Tweedy said.
They often don't feel there are other available options for care, either.
One approach some hospitals have started using — setting up urgent care clinics near their ERs in order to triage care — is less common in urban areas where many Medicaid recipients live, he said.
Virginia Medicaid is facing an unusual need for additional funds this year and next than the current budget for those years set aside: some
One reason for that is a
Others include a projected
In addition, increased payments to Medicare — the federal insurance program for people ages 65 or older and people with certain disabilities — and pharmacy rebates are pushing up Medicaid costs.
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