chartbook: medicaid pharmacy benefit use and reimbursement

Contract No.: 500-00-0047 (0002, Master 061) MPR Reference No.: 8929-953

Chartbook: Medicaid Pharmacy Benefit Use and Reimbursement in 2005 June 2009 Ann Bagchi James Verdier Dominick Esposito

Submitted to: Submitted by:

U.S. Department of Health and Human Services Mathematica Policy Research, Inc. Centers for Medicare & Medicaid Services P.O. Box 2393 Office of Research, Development, and Information Princeton, NJ 08543-2393 7500 Security Boulevard Telephone: (609) 799-3535 Baltimore, MD 21244 Facsimile: (609) 799-0005

Project Officer: Project Director:

David Baugh James Verdier

CHARTBOOK: MEDICAID PHARMACY BENEFIT USE AND REIMBURSEMENT IN 2005

INTRODUCTION AND OVERVIEW

This chartbook, prepared for the Centers for Medicare & Medicaid Services (CMS) by Mathematica Policy Research, Inc., presents highlights and key comparisons from the Statistical Compendium on Medicaid pharmacy benefit use and reimbursement in 2005. The 54 exhibits in the chartbook are summarized below.

Beneficiary Characteristics and Illustrative Use and Reimbursement Measures

Exhibit 1: Distribution of Medicaid Study Population Beneficiary Characteristics Exhibit 2: Illustrative Measures for Medicaid Study Population Pharmacy Benefit Use and

Reimbursement

Study Population Characteristics

Exhibit 3: Distribution of Medicaid Study Population by Age Group, Nondual and Dual Eligible Beneficiaries

Exhibit 4: Distribution of Medicaid Study Population by Disability Status, Nondual and Dual Eligible Beneficiaries

Exhibit 5: Distribution of Medicaid Study Population by Race, Nondual and Dual Eligible Beneficiaries

Medicaid Pharmacy Reimbursement and Use, by Type of Beneficiary

Exhibit 6: Average Monthly Medicaid Pharmacy Reimbursement, by Age Group Exhibit 7: Distribution of Medicaid Age Groups and Total Pharmacy Reimbursement Exhibit 8: Average Monthly Medicaid Pharmacy Reimbursement, by Basis of Eligibility and Dual

Status Exhibit 9: Percentage of Medicaid Beneficiaries with at Least One Prescription Drug Claim, by Dual

Eligibility Status Exhibit 10: Average Annual Number of Medicaid Prescription Drug Claims per Beneficiary, by Dual

Eligibility Status Exhibit 11: Number of Medicaid Prescriptions per Benefit Month, by Basis of Eligibility and Dual

Eligibility Status Exhibit 12: Average Annual Medicaid Prescription Drug Spending per Beneficiary, by Dual Eligibility

Status Exhibit 13: Distribution of Medicaid Dual Eligibility Status and Total Pharmacy Reimbursement

Medicaid Pharmacy Use and Reimbursement, Nondual Beneficiaries

Exhibit 14: Distribution of Medicaid Beneficiaries and Total Pharmacy Reimbursement among Nondual Beneficiaries, by Basis of Eligibility

Exhibit 15: Total Annual Medicaid Reimbursement for Top 10 Drug Groups among Nondual Beneficiaries

Exhibit 16: Percentage of Medicaid Pharmacy Reimbursement and Users for Top 10 Drug Groups among Nondual Beneficiaries

Exhibit 17: Percentage of Medicaid Pharmacy Reimbursement and Users for Top 7 Therapeutic Categories among Nondual Beneficiaries

Exhibit 18: Average Monthly Medicaid Pharmacy Reimbursement among Nondual Beneficiaries, by State

Medicaid Pharmacy Use and Reimbursement, Dual Eligible Beneficiaries

Exhibit 19: Generic Prescriptions as Percentage of All Medicaid Prescriptions among Nondual Beneficiaries, by State

Exhibit 20: Distribution of Medicaid Beneficiaries and Total Pharmacy Reimbursement among Dual Eligibles, by Basis of Eligibility

Exhibit 21: Total Annual Medicaid Reimbursement for Top 10 Drug Groups among Dual Eligibles Exhibit 22: Percentage of Medicaid Pharmacy Reimbursement and Users for Top 10 Drug Groups

Among Dual Eligibles Exhibit 23: Percentage of Medicaid Pharmacy Reimbursement and Users for Top 7 Therapeutic

Categories among Dual Eligibles Exhibit 24: Distribution of Annual Medicaid Pharmacy Reimbursement for Dual Eligibles, Under-Age-

65 Disabled vs. Age 65 and Older Exhibit 25: Average Monthly Medicaid Pharmacy Reimbursement among Dual Eligibles, by Beneficiary

Nursing Facility Residence Exhibit 26: Average Monthly Medicaid Pharmacy Reimbursement among Dual Eligibles, by State Exhibit 27: Generic Prescriptions as a Percentage of All Medicaid Prescriptions among Dual Eligibles, by

State Exhibit 28: Average Annual Medicaid Pharmacy Reimbursement Amount per Beneficiary for Aged Dual

Eligibles, by State Exhibit 29: Average Annual Medicaid Pharmacy Reimbursement Amount per Beneficiary for Under-

Age-65 Disabled Dual Eligible Beneficiaries, by State Exhibit 30: Average Annual Medicaid Pharmacy Reimbursement Amount per Beneficiary for Dual

Eligible All-Year Nursing Facility Residents, by State

Medicaid Pharmacy Use and Reimbursement, Drugs Excluded by Statute from Medicare Part D

Exhibit 31: Percentage of Medicaid Beneficiaries Using at Least One Drug Excluded from Medicare Part D

Exhibit 32: Annual Medicaid Pharmacy Reimbursement Per User for Drugs Excluded from Medicare Part D, Nondual and Dual Eligible Beneficiaries

Exhibit 33: Annual Medicaid Pharmacy Reimbursement for Drugs Excluded from Medicare Part D for Nondual and Dual Eligible Beneficiaries as a Percentage of Total Annual Medicaid Reimbursement for Nondual and Dual Eligible Beneficiaries

Medicaid Pharmacy Use and Reimbursement, 1999, 2001, 2002, 2003, 2004, and 2005

Overview Exhibit 34: Total Medicaid Pharmacy Reimbursement, 1999, 2000, 2001, 2003, 2004, and 2005 Exhibit 35: Medicaid Pharmacy Reimbursement as a Percentage of Costs on All Services, 1999, 2001,

2002, 2003, 2004, and 2005 Exhibit 36: Average Annual Medicaid Prescription Drug Reimbursement per Medicaid Beneficiary,

Nondual Beneficiaries and Dual Eligibles 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 37: Average Monthly Medicaid Pharmacy Reimbursement per Beneficiary, Nondual

Beneficiaries and Dual Eligibles 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 38: Percentage of Medicaid Beneficiaries with at Least One Prescription Filled, Nondual

Beneficiaries and Dual Eligibles 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 39: Average Annual Number of Prescription Claims per Medicaid Beneficiary, Nondual

Beneficiaries and Dual Eligibles 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 40: Brand Name and Generic Drugs as a Percentage of All Medicaid Claims, 1999, 2001, 2002,

2003, 2004, and 2005

3

4

By Basis of Eligibility Exhibit 41: Number of Medicaid Beneficiaries by Basis of Eligibility, 1999, 2001, 2002, 2003, 2004, and

2005 Exhibit 42: Average Monthly Medicaid Pharmacy Reimbursement by Basis of Eligibility, 1999, 2001,

2002, 2003, 2004, and 2005 Nondual Beneficiaries Exhibit 43: Number of Nondual Medicaid Beneficiaries by Basis of Eligibility, 1999, 2001, 2002, 2003,

2004, and 2005 Exhibit 44: Average Annual Number of Medicaid Prescription Claims by Basis of Eligibility, Nondual

Beneficiaries, 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 45: Average Annual Medicaid Prescription Reimbursement by Basis of Eligibility, Nondual

Beneficiaries, 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 46: Average Monthly Medicaid Prescription Reimbursement by Basis of Eligibility, Nondual

Beneficiaries, 1999, 2001, 2002, 2003, 2004, and 2005 Dual Eligible Beneficiaries Exhibit 47: Number of Dual Medicaid Beneficiaries by Basis of Eligibility, 1999, 2001, 2002, 2003,

2004, and 2005 Exhibit 48: Average Annual Number of Medicaid Prescription Claims by Basis of Eligibility, Dual

Eligible Beneficiaries, 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 49: Average Annual Medicaid Prescription Reimbursement by Basis of Eligibility, Dual Eligible

Beneficiaries, 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 50: Average Monthly Medicaid Prescription Reimbursement by Basis of Eligibility, Dual

Eligible Beneficiaries, 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 51: Average Annual Medicaid Drug Reimbursement Among Dual Eligible Beneficiaries by Age

Group and Disability Status, 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 52: Percentage of Dual Eligible Beneficiaries with Annual Drug Costs in Specified Ranges, 1999,

2001, 2002, 2003, 2004, and 2005 Exhibit 53: Number of Dual Eligible Full-Year Nursing Facility Residents and Under-Age-65 Disabled

Dual Eligible Beneficiaries Compared to All Duals, 1999, 2001, 2002, 2003, 2004, and 2005 Exhibit 54: Average Monthly Medicaid Pharmacy Reimbursement for Dual Eligible Full-Year Nursing

Facility Residents and Under-Age-65 Disabled Dual Eligible Beneficiaries Compared to All Duals, 1999, 2001, 2002, 2003, 2004, and 2005

BENEFICIARY CHARACTERISTICS AND ILLUSTRATIVE USE AND REIMBURSEMENT MEASURES

6

EXHIBIT 1

DISTRIBUTION OF MEDICAID STUDY POPULATION BENEFICIARY CHARACTERISTICS, 2005

Beneficiary Characteristics

Percent of Beneficiaries

Among All Medicaid

Beneficiariesa

Among Nondual

Beneficiariesb Among Dual

Eligiblesb

Among Beneficiaries Who Resided in

Nursing Facilities All Yearc

Age 5 and younger 21 25 < 1

15e

6–14 20 24 < 1 15–20 12 15 < 1 21–44 25 27 14 45–64 10 8 22 65–74 5 < 1 25 13 75–84 4 < 1 23 30 85 and older 3 < 1 15 43

Sex Male 40 40 37 29 Female 60 59 63 71

Race African American 23 24 18 14 White 45 43 58 75 Other/Unknown 32 33 23 11

Dual Eligibility Statusb Dual Eligibles 16 0 100 91 Nondual Beneficiaries 84 100 0 9

Basis of Eligibilityd Children 49 58 < 1 < 1 Adults 24 29 1 < 1 Disabled 17 12 43 18 Aged 10 1 56 82

Number of Beneficiaries in Study Population 42,599,571 35,581,286 7,018,285 865,173 Source: Medicaid Analytic Extract (MAX), 2005. This table is based on information contained in Tables 2, ND.2,

D.2, ND.8, and D.8 in the Statistical Compendium Volume, United States (hereafter “the Compendium”). aMedicaid beneficiaries featured in this chartbook include those who had fee-for-service (FFS) Medicaid pharmacy benefit coverage for at least one month during calendar year 2005. Beneficiaries who were in capitated managed care arrangements for the entire year are excluded. For more details on how we determined the study population, see Table 1 of the Compendium. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefit coverage for at least one month during their Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never

EXHIBIT 1 (continued) ___________________________________________________________________________________

7

dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefit coverage. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. cThis group includes beneficiaries who resided in nursing facilities throughout their Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined all-year nursing facility residency. dMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness. The children’s group includes children receiving foster care and adoptive services. eThe percentage represents all ages below 65.

8

EXHIBIT 2

ILLUSTRATIVE MEASURES OF MEDICAID STUDY POPULATION PHARMACY BENEFIT USE AND REIMBURSEMENT, 2005a

Measures of Pharmacy Benefit Use and Reimbursement

Among All Medicaid

Beneficiariesb

Among Nondual

Beneficiariesb Among Dual

Eligiblesb

Among Beneficiaries Who Resided in Nursing

Facilities All Yearb

Total Medicaid Pharmacy Reimbursement (in $ million) $40,187 $18,333 $21,854 $3,436

Average Annual Pharmacy Reimbursement per Beneficiaryc $943 $515 $3,114 $3,971

Average Pharmacy Reimbursement per Benefit Monthd $114 $66 $295 $392

Average Annual Number of Prescriptions per Beneficiary 13.5 7.3 45.2 69.9

Average Number of Prescriptions per Benefit Month 1.6 0.9 4.3 6.9 Source: Medicaid Analytic Extract (MAX), 2005. This table is based on information contained in Tables 3, 4, 6,

ND.3, ND.4, ND.6, ND.8, ND.9, D.3, D.4, D.6, D.8, D.9, and N.1a in the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bSee footnotes to Exhibit 1 for how these groups were defined. Annual or monthly measures reflect use and reimbursement among beneficiaries in FFS settings, and may thus be higher or lower than if use and reimbursement in capitated managed care settings were included. cAnnual per-beneficiary use and reimbursement include all use and reimbursement during the year for the number of months of Medicaid FFS pharmacy benefit coverage. Thus, some beneficiaries may have had only one month of coverage, while others were covered for twelve months. Medicaid beneficiaries in the study population had, on average, 8.3 months of coverage. The comparable number was 7.8 months among nondual beneficiaries and 10.6 months among dual eligible beneficiaries, and 10.1 months among beneficiaries who resided in nursing facilities throughout their Medicaid enrollment in 2005. dMonthly use and reimbursement amounts were calculated by dividing total use and reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

STUDY POPULATION CHARACTERISTICS

EXHIBIT 3

DISTRIBUTION OF MEDICAID STUDY POPULATION BY AGE GROUP,

NONDUAL AND DUAL ELIGIBLE BENEFICIARIES, 2005a

64%

35%

1% 0%

37%

63%

0%

25%

50%

75%

100%

Under 21 21 to 64 65 and Older Under 21 21 to 64 65 and Older

Nondual Beneficiaries Dual Eligibles

10

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables ND.2 and D.2 of the Compendium. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 4

DISTRIBUTION OF MEDICAID STUDY POPULATION BY DISABILITY STATUS,

NONDUAL AND DUAL ELIGIBLE BENEFICIARIES, 2005a,b

12%

88%

43%

57%

0%

25%

50%

75%

100%

Disabled Non-disabled Disabled Non-disabled


11

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables ND.2 and D.2 of the Compendium. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. bThe disabled eligibility group includes beneficiaries of any age who were determined to be eligible for Medicaid because of disability or blindness.

EXHIBIT 5

DISTRIBUTION OF MEDICAID STUDY POPULATION BY RACE,

NONDUAL AND DUAL ELIGIBLE BENEFICIARIES, 2005a

24%

43%

33%

18%

58%

23%

0%

25%

50%

75%

100%

African American White Other/Unknown African American White Other/Unknown


12


MEDICAID PHARMACY REIMBURSEMENT AND USE, BY TYPE OF BENEFICIARY

EXHIBIT 6

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT,

BY AGE GROUP, 2005a,b

$114

$23$37 $42

$109

$314

$254 $252$233

$0

$25

$50

$75

$100

$125

$150

$175

$200

$225

$250

$275

$300

$325

All 5 and Younger

6 to 14 15 to 20 21 to 44 45 to 64 65 to 74 75 to 84 85 and Older

Age

14

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table 4 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

15

EXHIBIT 7

DISTRIBUTION OF MEDICAID AGE GROUPS AND TOTAL PHARMACY REIMBURSEMENT, 2005a

65 and Older

45 to 64

21 to 44

20 and Younger 53%

14%

25%

22%

10%

33%

12%

30%

0%

20%

40%

60%

80%

100%

Percent of Beneficiaries Percent of Pharmacy Reimbursement

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables 2, 3, and 6 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states.

EXHIBIT 8

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT,

BY BASIS OF ELIGIBILITY AND DUAL STATUS, 2005a,b,c,d

$114

$25$45

$295

$240

$66

$295

$0

$50

$100

$150

$200

$250

$300

$350

All Children Adults Disabled Aged Nondual Beneficiaries

Dual Eligibles

Eligibility Status Dual Status

16

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables 4, ND.4, and D.4 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage. cMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 9

PERCENTAGE OF MEDICAID BENEFICIARIES WITH AT LEAST ONE PRESCRIPTION DRUG CLAIM,

BY DUAL ELIGIBILITY STATUS, 2005a

56%

86%

0%

25%

50%

75%

100%


17


EXHIBIT 10

AVERAGE ANNUAL NUMBER OF MEDICAID PRESCRIPTION DRUG CLAIMS PER BENEFICIARY,

BY DUAL ELIGIBILITY STATUS, 2005a,b

7.3

45.2

0

10

20

30

40

50


18

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables ND.3 and D.3 of the Compendium. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. bNondual beneficiaries, on average, had fewer months of Medicaid eligibility in 2005 than dual eligible beneficiaries: 7.8 months for nonduals and 10.5 months for duals.

19

EXHIBIT 11

NUMBER OF MEDICAID PRESCRIPTIONS PER BENEFIT MONTH, BY BASIS OF ELIGIBILITY AND DUAL ELIGIBILITY STATUS, 2005a,b

2.62.8

0.80.5

4.3 4.3

3.23.0

0

1

2

3

4

5

Aged Disabled Adults Children Aged Disabled Adults Children


Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables ND.4 and D.4 of the Compendium. aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

20

EXHIBIT 12

AVERAGE ANNUAL MEDICAID PRESCRIPTION DRUG SPENDING PER BENEFICIARY, BY DUAL ELIGIBILITY STATUS, 2005a,b

$515

$3,114

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500


Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables ND.3 and D.3 of the Compendium. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. bNonduals, on average, had fewer months of Medicaid eligibility in 2005 than dual eligible beneficiaries: 7.8 months for nonduals and 10.6 months for duals.

21

EXHIBIT 13

DISTRIBUTION OF MEDICAID DUAL ELIGIBILITY STATUS AND TOTAL PHARMACY REIMBURSEMENT, 2005a,b

Dual

16%

54%

84%

46%

0%

25%

50%

75%

100%

Percent of Beneficiaries Percent of Total Pharmacy Reimbursement

Nondual

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables 2, ND.2, D.2, 6, ND.6, and D.6 of the

Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

MEDICAID PHARMACY USE AND REIMBURSEMENT, NONDUAL BENEFICIARIES

EXHIBIT 14

DISTRIBUTION OF MEDICAID BENEFICIARIES AND TOTAL PHARMACY REIMBURSEMENT AMONG NONDUAL BENEFICIARIES, BY BASIS OF ELIGIBILITY, 2005a,b,c

58%

22%

29%

17%

12%

59%

1% 2%

0%

25%

50%

75%

100%

Percent of Beneficiaries Percent of Pharmacy Reimbursement

Aged

Disabled

Adults

Children

23

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables ND.2, ND.3, and ND.6 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. cDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 15

TOTAL ANNUAL MEDICAID REIMBURSEMENT FOR TOP 10 DRUG GROUPS AMONG NONDUAL BENEFICIARIES, 2005a,b,c,d

The top 10 drug groups (out of over 90 drug groups) accounted for 57 percent of total Medicaid FFS pharmacy reimbursement for nondual beneficiaries in 2005.

$2,466

$1,273 $1,221$1,139

$1,020$867

$689 $667 $613 $610

$0

$500

$1,000

$1,500

$2,000

Antipsychotics Antiasthmatic Anticonvulsant Antiviral Antidepressants Ulcer Drugs Stimulants/Anti-obesity/Anorexiants

Analgesics -Narcotic

Antidiabetic Antihyperlipidemic

$2,500($ million)

24

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table ND.7 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bAnnual per-beneficiary reimbursement includes all reimbursement during the year for the number of months of Medicaid FFS pharmacy benefit coverage. Thus, some beneficiaries may have had only one month of coverage, while others were covered for twelve months. At the national level, nondual eligible Medicaid beneficiaries in the study population had, on average, 7.8 months of coverage. cThe top 10 drug groups were determined based on total Medicaid reimbursement in 2005. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 16

PERCENTAGE OF MEDICAID PHARMACY REIMBURSEMENT AND USERS FOR TOP 10 DRUG GROUPS AMONG NONDUAL BENEFICIARIES, 2005a,b,c,d

13%

7% 7% 6% 6% 5% 4% 4% 3% 3%5%

18%

5%

2%

10%8%

4%

18%

4% 3%

0%

5%

10%

15%

20%

Antipsychotics Antiasthmatic Anticonvulsant Antiviral Antidepressants Ulcer Drugs Stimulants/Anti-obesity/Anorexiants

Analgesics -Narcotic

Antidiabetic Antihyperlipidemic

Percent of Nondual Beneficiary Pharmacy Reimbursement Percent of Nondual Beneficiaries

25

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table ND.7 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bA user is a beneficiary who had at least one prescription filled in a given therapeutic category during 2005. A beneficiary who used drugs from two or more categories was counted as a user for each category. Therefore, the sum of users across categories may exceed the total number of individual users. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). cThe top 10 drugs groups were determined based on total Medicaid reimbursement in the state for 2005. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 17

PERCENTAGE OF PHARMACY MEDICAID REIMBURSEMENT AND USERS FOR TOP 7 THERAPEUTIC CATEGORIES AMONG NONDUAL BENEFICIARIES, 2005a,b,c,d

The top 7 therapeutic categories (out of 18 therapeutic categories) accounted for 74 percent of total Medicaid FFS pharmacy reimbursement for nondual beneficiaries in 2005

21%

13%11%

8% 8% 8% 7%

11%

36%

25%

8% 7%

15%

21%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Central Nervous System Drugs

Anti-infective Agents Respiratory Agents Cardiovascular Agents Neuromuscular Agents Endocrine/ Metabolic Drugs

Analgesics and Anesthetics

Percent of Nondual BeneficiariesPercent of Nondual Beneficiary Pharmacy Reimbursement

26

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table ND.6 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bA user is a beneficiary who had at least one prescription filled in a given therapeutic category during 2005. A beneficiary who used drugs from two or more categories was counted as a user for each category. Therefore, the sum of users across categories may exceed the total number of individual users. For information about these therapeutic categories, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007) . cTop 7 categories were determined based on total Medicaid reimbursement in 2005. For information about these therapeutic categories, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). cDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 18

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT AMONG NONDUAL BENEFICIARIES, BY STATE, 2005a,b,c

$13$40$41$42$42$43$44$44$45$45$46$47

$49$50$51

$54$54$55

$56$58$58

$62$65$66$66$67$67

$71$72$72

$75$76

$80$81

$83$86

$89$93$93

$96$96

$102$104

$108$136

$159$164$164

$195$263

$0 $50 $100 $150 $200 $250

NMARMDSDMSSCCOALOKWY

ILCAGAID

NDNHMILAUTMTTXIA

ORVT

USAWIAKKSNCTNFL

WAVADEKYMAPAOHNEIN

NVMONYMNWV

RINJ

DCHICT

27

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table N.2 of the Compendium for the nation. The Compendium was prepared for 48 states (excluding Arizona and Maine) and the District of Columbia. FFS pharmacy reimbursement information is not available for Arizona due to a very high share of beneficiary enrollment in prepaid managed care plans.

aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage. cDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 19 GENERIC PRESCRIPTIONS AS PERCENTAGE OF ALL MEDICAID PRESCRIPTIONS

AMONG NONDUAL BENEFICIARIES, BY STATE, 2005a,b

46.650.4

50.752.1

52.452.9

53.253.3

54.054.1

54.655.155.155.1

55.455.4

55.855.9

56.356.4

56.856.956.957.057.1

57.658.0

58.358.458.6

58.858.858.9

59.259.4

59.660.060.0

60.560.760.8

61.662.6

63.263.6

64.064.7

65.465.565.5

65.7

40.0 45.0 50.0 55.0 60.0 65.0 70.0

NMNJ

NYSDLADCCT

MDAKNCIA

ARRI

PAKSCAOHFLTX

MNDESC

WYNE

USANDVAWVMSWITNID

VTMIGAIN

NHMOMTCOOKKYNVMAUTIL

ALWAORNM

HI

28

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table N.2 of the Compendium for the nation. The Compendium was

prepared for 48 states (excluding Arizona and Maine) and the District of Columbia. FFS pharmacy reimbursement information is not available for Arizona due to a very high share of beneficiary enrollment in prepaid managed care plans.

aBrand-name drugs, sometimes called “innovator single-source drugs,” are drugs whose patents have not yet expired. Off-patent brand-name drugs, sometimes called “innovator multiple-source drugs,” are brand-name drugs whose patents have expired. Generic drugs, sometimes called “non-innovator multiple-source drugs,” are off-patent drugs manufactured and sold by companies other than the original patent holder. For information about this classification method, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

MEDICAID PHARMACY USE AND REIMBURSEMENT, DUAL ELIGIBLE BENEFICIARIES

EXHIBIT 20

DISTRIBUTION OF MEDICAID BENEFICIARIES AND TOTAL PHARMACY REIMBURSEMENT AMONG DUAL ELIGIBLES, BY BASIS OF ELIGIBILITY, 2005a,b,c,d

43%54%

56%45%

0%

25%

50%

75%

100%

Percent of Beneficiaries Percent of Total Pharmacy Reimbursement

Aged

Disabled

30

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables D.2, D.3, and D.6 of the Compendium. aChildren and adults comprise less than 1 percent each of dual eligible beneficiaries both in percentage of beneficiaries and in percentage of pharmacy reimbursement. bThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. cMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 21

TOTAL ANNUAL MEDICAID REIMBURSEMENT FOR TOP 10 DRUG GROUPS AMONG DUAL ELIGIBLES, 2005A,B,C,D

The top 10 drug groups (out of over 90 drug groups) accounted for 61 percent of total Medicaid FFS pharmacy reimbursement for dual eligibles in 2005.

($ million) $2,902

$1,626 $1,554

$1,255 $1,238 $1,199

$923 $917 $894 $838

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

Antipsychotic Antihyperlipidemic Ulcer Drugs Anticonvulsant Antidepressants Antidiabetic Analgesics -Narcotic

Antihypertensive Antiasthmatic Antiviral

31

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table D.7 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bAnnual per-beneficiary reimbursement includes all reimbursement during the year for the number of months of Medicaid FFS pharmacy benefit coverage. Thus, some beneficiaries may have had only one month of coverage, while others were covered for twelve months. At the national level, dual eligible Medicaid beneficiaries in the study population had, on average, 10.6 months of coverage. cThe top 10 drug groups were determined based on total Medicaid reimbursement in 2005. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 22

PERCENTAGE OF MEDICAID PHARMACY REIMBURSEMENT AND USERS FOR TOP 10 DRUG GROUPS AMONG DUAL ELIGIBLES, 2005A,B,C,D

13%

7% 7% 6% 6% 5% 4% 4% 4% 4%

25%

35%

42%

23%

44%

37%

54%

48%

36%

5%

0%

10%

20%

30%

40%

50%

60%

Antipsychotic Antihyperlipidemic Ulcer Drugs Anticonvulsant Antidepressants Antidiabetic Analgesics - Narcotic Antihypertensive Antiasthmatic Antiviral

Percent of Dual Eligible Pharmacy Reimbursement Percent of Dual Eligible Beneficiaries

32

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table D.7 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bA user is a beneficiary who had at least one prescription filled in a given therapeutic category during 2005. A beneficiary who used drugs from two or more categories was counted as a user for each category. Therefore, the sum of users across categories may exceed the total number of individual users. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). cThe top 10 drugs groups were determined based on total Medicaid reimbursement in the state for 2005. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

33

The top 7 therapeutic categories (out of 18 therapeutic categories) accounted for 77 percent of total Medicaid FFS pharmacy reimbursement for dual beneficiaries in 2005

EXHIBIT 23

PERCENTAGE OF MEDICAID PHARMACY REIMBURSEMENT AND USERS FOR TOP 7 THERAPEUTIC CATEGORIES AMONG DUAL ELIGIBLES, 2005A,B,C,D

21% 18%9% 8% 8% 7% 7%

49%

64%

41% 44%50%

28%

52%

0%

25%

50%

75%

100%

Central Nervous System Drugs

Cardiovascular Agents

Gastrointestinal Agents

Endocrine/ Metabolic Drugs

Analgesics and Anesthetics

Neromuscular Agents

Anti-infective Agents

Percent of Dual Eligible BeneficiariesPercent of Dual Eligible Pharmacy Reimbursement

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table D.6 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bA user is a beneficiary who had at least one prescription filled in a given therapeutic category during 2005. A beneficiary who used drugs from two or more categories was counted as a user for each category. Therefore, the sum of users across categories may exceed the total number of individual users. For information about these therapeutic categories, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). cTop 7 categories were determined based on total Medicaid reimbursement in 2005. For information about these therapeutic categories, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 24

DISTRIBUTION OF ANNUAL MEDICAID PHARMACY REIMBURSEMENT FOR

DUAL ELIGIBLES, UNDER-AGE-65 DISABLED VS. AGE 65 AND OLDER, 2005a,b,c

Disabled Dual Eligibles Under Age 65

Dual Eligibles Age 65 and Older

38%

2%

38%

4%

35%

23%

45%

45%

17%

30%

14%

35%

11%

45%

3%

16%

0%

20%

40%

60%

80%

100%

Percent of Beneficiaries Percent of Expenditures Percent of Beneficiaries Percent of Expenditures

$10,000 and more

$10,000 and more $5,001 to

$10,000

$5,001 to $10,000 $1,000 to

$5,000 $1,000 to

$5,000

$0 to $1,000 $0 to

$1,000

(Total Benes = 2.5 million) (Total Exp. = $9.9 billion) (Total Benes = 4.4 million) (Total Exp. = $11.7)

34

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Supplemental Tables 1A and 1B of the Compendium for

the nation. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bAnnual per-beneficiary reimbursement includes all reimbursement during the year for the number of months of Medicaid FFS pharmacy benefit coverage. Thus, some beneficiaries may have had only one month of coverage, while others were covered for twelve months. At the national level, dual eligible Medicaid beneficiaries in the study population had, on average, 10.6 months of coverage in 2005. cDual eligibles include beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefit coverage during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 25

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT AMONG DUAL ELIGIBLES, BY BENEFICIARY NURSING FACILITY RESIDENCE, 2005A,B,C

$295

$377

$342

$281

$150

$175

$200

$225

$250

$275

$300

$325

$350

$375

$400

All Duals Dual All-Year NF Residents Dual Part-Year NF Residents Dual With No NF Use

35

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table D.4 of the Compendium. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage. cDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

36

EXHIBIT 26

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT AMONG DUAL ELIGIBLES, BY STATE, 2005A,B

$64$201

$211$213

$239$243$245

$250$251$251

$259$265

$271$272$272

$283$283

$288$288

$291$292

$295$300

$311$312$314

$316$323$323$324$324

$328$328$329

$333$334$335

$340$346$347

$356$359$361

$364$365

$390$396

$418$459

$479

$50 $75 $100 $125 $150 $175 $200 $225 $250 $275 $300 $325 $350 $375 $400 $425 $450 $475 $500

NMSCMS

ILDCWIALARMDTXOKMANVMIGAWAORCONDKYCA

USAHI

VTWY

FLVATNSDLANYWVMT

RIIA

DENHKSIN

MNIDPAOHUTNCMOCTNJ

AKNE

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table N.5 of the Compendium for the nation. The Compendium was

prepared for 48 states (excluding Arizona and Maine) and the District of Columbia. FFS pharmacy reimbursement information is not available for Arizona due to a very high share of beneficiary enrollment in prepaid managed care plans.

aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bMonthly use and reimbursement amounts were calculated by dividing the total use and reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage. cDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 27

GENERIC PRESCRIPTIONS AS A PERCENTAGE OF ALL MEDICAID PRESCRIPTIONS AMONG DUAL ELIGIBLES, BY STATE, 2005A,B

44.848.2

49.550.4

51.751.9

52.752.9

53.454.154.2

54.655.5

55.855.956.056.2

56.756.856.9

57.457.7

57.958.058.058.0

58.358.358.458.558.658.758.7

59.259.559.659.659.759.9

61.161.3

61.561.7

62.162.3

62.864.0

64.866.5

68.0

35.0 37.0 39.0 41.0 43.0 45.0 47.0 49.0 51.0 53.0 55.0 57.0 59.0 61.0 63.0 65.0 67.0 69.0

NYNJ

AKCANCTXFLCTLADCRI

MDOH

USADESDSCPAIA

ARMNVT

NMNEIDKSUTVATNMSGAHIIN

MOCONDWVWYNHWIIL

MIMTNVMAOKKYWAORAL

Percentage

37

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table N.5 of the Compendium for the nation. The Compendium was prepared for 48 states (excluding Arizona and Maine) and the District of Columbia. FFS pharmacy reimbursement information is not available for Arizona due to a very high share of beneficiary enrollment in prepaid managed care plans.

aBrand-name drugs, sometimes called “innovator single-source drugs,” are drugs whose patents have not yet expired. Off-patent brand-name drugs, sometimes called “innovator multiple-source drugs,” are brand-name drugs whose patents have expired. Generic drugs, sometimes called “non-innovator multiple-source drugs,” are off-patent drugs manufactured and sold by companies other than the original patent holder. For information about this classification method, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007). bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

38

EXHIBIT 28

AVERAGE ANNUAL MEDICAID PHARMACY REIMBURSEMENT AMOUNT PER BENEFICIARY FOR AGED DUAL ELIGIBLES, BY STATE, 2005A,B,C

$966$1,327

$1,454$1,607

$1,725$1,970

$2,165$2,171

$2,206$2,260

$2,291$2,400

$2,438$2,443

$2,464$2,475$2,480

$2,534$2,556

$2,575$2,589$2,597

$2,622$2,624

$2,663$2,685$2,688

$2,771$2,773

$2,792$2,813$2,829

$2,876$2,889$2,890

$2,910$2,944$2,947

$3,003$3,026

$3,124$3,155

$3,189$3,297

$3,350$3,400

$3,465$3,473

$3,547$3,619

$900 $1,400 $1,900 $2,400 $2,900 $3,400 $3,900

NMMNDCIL

SCWI

MDORMANVMSMINYOKCO

WACA

USAHIFLALMTGATXNDARVT

WYUTRI

DEKYNEIA

NHTNIN

VAIDKSPASDOHMOWVCTNCAKNJLA

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in State Tables D.3 of the Compendium. The Compendium was prepared for 48 states (excluding Arizona and Maine) and the District of Columbia. FFS pharmacy reimbursement information is not available for Arizona due to a very high share of beneficiary enrollment in prepaid managed care plans.

aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bAnnual per-beneficiary reimbursement includes all reimbursement during the year for the number of months of Medicaid FFS pharmacy benefit coverage. Thus, some beneficiaries may have had only one month of coverage, while others were covered for twelve months. At the national level, aged dual eligible Medicaid beneficiaries in the study population had, on average, 10.3 months of coverage. cDual eligibles include beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefit coverage during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 29

AVERAGE ANNUAL MEDICAID PHARMACY REIMBURSEMENT AMOUNT PER BENEFICIARY FOR

UNDER-AGE-65 DISABLED DUAL ELIGIBLE BENEFICIARIES, BY STATE, 2005a,b,c

$469$2,418

$2,592$2,693

$2,871$3,074

$3,163$3,170$3,199

$3,248$3,352$3,354

$3,451$3,473$3,485$3,514

$3,613$3,624$3,647$3,657

$3,700$3,754

$3,813$3,826

$3,875$3,886

$3,924$3,944$3,944$3,953

$4,105$4,145$4,150$4,155

$4,260$4,282$4,295$4,298

$4,377$4,420$4,424

$4,479$4,506$4,517

$4,556$4,793

$4,856$5,334

$5,504$6,100

$100 $600 $1,100 $1,600 $2,100 $2,600 $3,100 $3,600 $4,100 $4,600 $5,100 $5,600 $6,100

NMMSARALTXGASCOKKYMIORNDMDDCLAIL

MAWVNVSD

WAPAWICO

WYUSAMTVATNKSNHCAVTFLIA

DERI

MNOHNCIN

NEHIID

UTNYMONJCTAK

39

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in State Tables D.3 of the Compendium. The Compendium was prepared for 48 states (excluding Arizona and Maine) and the District of Columbia. FFS pharmacy reimbursement information is not available for Arizona due to a very high share of beneficiary enrollment in prepaid managed care plans.

aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bAnnual per-beneficiary reimbursement includes all reimbursement during the year for the number of months of Medicaid FFS pharmacy benefit coverage. Thus, some beneficiaries may have had only one month of coverage, while others were covered for twelve months. At the national level, disabled dual eligible Medicaid beneficiaries in the study population had, on average, 10.9 months of coverage. cDual eligibles include beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefit coverage during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 30

AVERAGE ANNUAL MEDICAID PHARMACY REIMBURSEMENT AMOUNT PER BENEFICIARY FOR

DUAL ELIGIBLE ALL-YEAR NURSING FACILITY RESIDENTS, BY STATE, 2005a,b,c

$472$1,272

$2,034$2,420

$2,882$2,911

$2,960$3,005

$3,315$3,359

$3,424$3,472$3,477

$3,546$3,552$3,563

$3,618$3,669

$3,747$3,796$3,807$3,811$3,812$3,831$3,839

$3,914$3,979

$4,034$4,077$4,092$4,102$4,105$4,106

$4,196$4,233

$4,297$4,369

$4,474$4,479$4,506$4,520

$4,603$4,657

$4,811$4,822$4,850

$4,981$5,009

$5,715$6,618

$400 $800 $1,200 $1,600 $2,000 $2,400 $2,800 $3,200 $3,600 $4,000 $4,400 $4,800 $5,200 $5,600 $6,000 $6,400

DCNYSC

MNORHI

MAARNVMI

WAMTWINDVTDE

WYNM

IAIDFLCO

USAMDNHNEGACAALOKSDIL

WVKSKYINCTVAMSRI

PAUTOHTNTX

MONJ

NCLAAK

40

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in State Tables D.3 of the Compendium. The Compendium was prepared

for 48 states (excluding Arizona and Maine) and the District of Columbia. FFS pharmacy reimbursement information is not available for Arizona due to a very high share of beneficiary enrollment in prepaid managed care plans.

aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bAnnual per-beneficiary reimbursement includes all reimbursement during the year for the number of months of Medicaid FFS pharmacy benefit coverage. Thus, some beneficiaries may have had only one month of coverage, while others were covered for twelve months. At the national level, dual eligible Medicaid beneficiaries in the study population who resided in nursing facilities full-year had, on average, 10.1 months of coverage. cDual eligibles include beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefit coverage during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

41

MEDICAID PHARMACY USE AND REIMBURSEMENT, DRUGS EXCLUDED BY STATUTE FROM MEDICARE PART D

EXHIBIT 31

PERCENTAGE OF MEDICAID BENEFICIARIES USING AT LEAST ONE DRUG EXCLUDED FROM MEDICARE PART D, 2005a,b

44%

56%At Least 1 Drug

Excluded from Part D

At Least 1 Drug


73%

27%

No Drugs Excluded from

Part D No Drugs


Nondual Beneficiaries 35,581,286

Dual Eligibles 7,018,285

42

Source: Medicaid Analytic Extract (MAX), 2005. These graph are based on the information contained in Tables ND.11 and D.11 of the Compendium. aThe statute that established the Medicare Part D drug benefit excluded several types of drugs from Part D coverage. State Medicaid programs are required to continue covering these drugs for dual eligibles if they are covered for any other Medicaid beneficiaries. Drugs excluded from the Medicare Part D drug benefit include benzodiazepines; barbiturates; nonprescription (OTC) medications; prescription vitamins and minerals (not including prenatal vitamins and fluoride preparations); and drugs used for anorexia, weight loss, or weight gain. Other excluded drugs include those that promote fertility; those used for cosmetic purposes or hair growth, for symptomatic relief of coughs and colds; or drugs for which the manufacturer requires that associated tests or monitoring services be purchased exclusively from the manufacturer. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

43

EXHIBIT 32

ANNUAL MEDICAID PHARMACY REIMBURSEMENT PER USER FOR DRUGS EXCLUDED FROM MEDICARE PART D, NONDUAL AND DUAL ELIGIBLE BENEFICIARIES, 2005a,b

$197 $183

$20 $37$60

$40 $43

$103

$223

$280

$442

$32$62

$103 $87 $74$101

$342

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

Anorexia or Weight

Loss/Gain

Fertility Drugs Drugs for Cosmetic Purposes

Cough and Cold Medications

Vitamins and Minerals

Non-prescription Drugs

Barbiturates Benzodiazepines Other Part D Excl Rx Drugs

Nondual Beneficiaries Dual Eligibles Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables ND.13 and D.13 of the Compendium. aThe statute that established the Medicare Part D drug benefit excluded several types of drugs from Part D coverage. State Medicaid programs are required to continue covering these drugs for dual eligibles if they are covered for any other Medicaid beneficiaries. Drugs excluded from the Medicare Part D drug benefit include benzodiazepines; barbiturates; nonprescription (OTC) medications; prescription vitamins and minerals (not including prenatal vitamins and fluoride preparations); and drugs used for anorexia, weight loss, or weight gain. Other excluded drugs include those that promote fertility; those used for cosmetic purposes or hair growth, for symptomatic relief of coughs and colds; or drugs for which the manufacturer requires that associated tests or monitoring services be purchased exclusively from the manufacturer. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 33

ANNUAL MEDICAID PHARMACY REIMBURSEMENT FOR DRUGS EXCLUDED FROM MEDICARE PART D FOR NONDUAL AND

DUAL ELIGIBLE BENEFICIARIES AS A PERCENTAGE OF TOTAL ANNUAL MEDICAID REIMBURSEMENT FOR NONDUAL AND DUAL ELIGIBLE BENEFICIARIES, 2005a,b

0.0% 0.0% 0.0%

0.8%

0.3%

1.2%

0.0%

0.7%

0.3%

0.0% 0.0% 0.0%

0.2%

0.6%

0.9%

0.0%

0.7%

0.2%

0.0%

0.3%

0.6%

0.9%

1.2%

1.5%

Anorexia or Weight Loss/Gain

Fertility Drugs Drugs for Cosmetic Purposes

Cough and Cold Medications

Vitamins and Minerals

Non-prescription Drugs

Barbiturates Benzodiazepines Other Part D Excl Rx Drugs


44

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables ND.13 and D.13 of the Compendium. aThe statute that established the Medicare Part D drug benefit excluded several types of drugs from Part D coverage. State Medicaid programs are required to continue covering these drugs for dual eligibles if they are covered for any other Medicaid beneficiaries. Drugs excluded from the Medicare Part D drug benefit include benzodiazepines; barbiturates; nonprescription (OTC) medications; prescription vitamins and minerals (not including prenatal vitamins and fluoride preparations); and drugs used for anorexia, weight loss, or weight gain. Other excluded drugs include those that promote fertility; those used for cosmetic purposes or hair growth, for symptomatic relief of coughs and colds; or drugs for which the manufacturer requires that associated tests or monitoring services be purchased exclusively from the manufacturer. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

MEDICAID PHARMACY USE AND REIMBURSEMENT, 1999, 2001, 2002, 2003, 2004, AND 2005

EXHIBIT 34

TOTAL MEDICAID PHARMACY REIMBURSEMENT, 1999, 2001, 2002, 2003, 2004, AND 2005a,b

(million)

$15,588

$22,910

$27,064

$33,513

$38,471$40,187

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

$45,000

1999 2001 2002 2003 2004 2005

46

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table 6 of the 1999, 2001, 2002, 2003, 2004, and 2005

Compendiums. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

EXHIBIT 35

MEDICAID PHARMACY REIMBURSEMENT AS A PERCENTAGE OF COSTS OF ALL SERVICES,

1999, 2001, 2002, 2003, 2004, AND 2005a,b,c

12% 15% 15% 17% 19% 19%

0%

25%

50%

75%

100%

1999 2001 2002 2003 2004 2005

47

47

47


Compendiums. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage. cIn seven states in 2004 (DE, IA, NE, NY, TX, UT, and WV) and 8 states in 2005 (DE, IA, IL, NE, NY, TX, UT, and WV), expenditures include only Rx drug expenditures for those enrolled in capitated managed care plans, and not expenditures for other services covered by the plans or long-term-care services not covered by the plans. In NV, managed care plans provided a pharmacy benefit only to dual eligibles and not nondual beneficiaries. As a result, pharmacy reimbursement as a percentage of the costs of all Medicaid services is higher in 2004 and 2005 than they would otherwise be.

EXHIBIT 36

AVERAGE ANNUAL PRESCRIPTION DRUG REIMBURSEMENT PER MEDICAID BENEFICIARY, NONDUAL BENEFICIARIES AND

DUAL ELIGIBLES, 1999, 2001, 2002, 2003, 2004, AND 2005a,b,c

$298 $362 $385 $459 $504 $515

$1,629

$2,203$2,387

$2,659$2,980 $3,114

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

1999 2001 2002 2003 2004 2005


48

48

48

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Tables ND3 and D3 of the 1999, 2001, 2002, 2003,

2004, and 2005 Compendiums. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. bThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. cMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

EXHIBIT 37

AVERAGE MONTHLY PHARMACY REIMBURSEMENT PER MEDICAID BENEFICIARY, NONDUAL BENEFICIARIES AND DUAL

ELIGIBLES, 1999, 2001, 2002, 2003, 2004, AND 2005a,b,c

$41 $48 $52 $59 $65 $66

$157

$211$233

$252

$283$295

$0

$50

$100

$150

$200

$250

$300

1999 2001 2002 2003 2004 2005


49

49

49


2004, and 2005 Compendiums. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. bThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states.

cMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

EXHIBIT 38

PERCENTAGE OF MEDICAID BENEFICIARIES WITH AT LEAST ONE PRESCRIPTION FILLED, NONDUAL BENEFICIARIES AND

DUAL ELIGIBLES, 1999, 2001, 2002, 2003, 2004, AND 2005a

55% 52% 53%56% 56% 56%

84% 86% 85% 84% 86% 86%

0%

20%

40%

60%

80%

100%

1999 2001 2002 2003 2004 2005


50

50

50


2004, and 2005 Compendiums. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 39

AVERAGE ANNUAL NUMBER OF PRESCRIPTION CLAIMS PER MEDICAID BENEFICIARY, NONDUAL BENEFICIARIES AND

DUAL ELIGIBLES, 1999, 2001, 2002, 2003, 2004, AND 2005a

6.4 6.4 6.5 7.3 7.3 7.3

34.8

39.6 40.242.3

44.7 45.2

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

1999 2001 2002 2003 2004 2005


51

51

51


2004, and 2005 Compendiums.

aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Nondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 40

BRAND NAME AND GENERIC DRUGS AS A PERCENTAGE OF ALL MEDICAID CLAIMS, 1999, 2001, 2002, 2003, 2004, AND 2005a

50% 53%47% 50% 47% 44%

50% 47%53% 50% 53% 56%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1999 2001 2002 2003 2004 2005

Brand Name Generic

52

52

52

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table 5 of the 1999, 2001, 2002, 2003, 2004, and 2005 Compendiums.

aBrand-name drugs, sometimes called “innovator single-source drugs,” are drugs whose patents have not yet expired. Off-patent brand-name drugs, sometimes called “innovator multiple-source drugs,” are brand-name drugs whose patents have expired. Generic drugs, sometimes called “non-innovator multiple-source drugs,” are off-patent drugs manufactured and sold by companies other than the original patent holder. For information about this classification method, see Wolters Kluwer Health, [http://www.medispan.com/marketing/ContentPage.aspx?contentId=09e0f1ed-80a9-4a87-8bc9-ad778d7b6615] (October 26 2007).

EXHIBIT 41

NUMBER OF MEDICAID BENEFICIARIES BY BASIS OF ELIGIBILITY, 1999, 2001, 2002, 2003, 2004, AND 2005a

28.6

3.3

5.7 5.3

14.2

34.4

3.4

6.1

8.6

16.2

38.2

3.6

6.7

9.9

17.9

40.7

4.1

6.9

10.1

19.6

42.4

4.2

7.2

10.3

20.7

42.6

4.2

7.3

10.3

20.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

All Beneficiaries Aged Disabled Adults Children

45.0(million)

1999 2001 2002 2003 2004 2005

53

53

53

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table 2 of the 1999, 2001, 2002, 2003, 2004, and 2005 Compendiums.

aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility.

EXHIBIT 42

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT BY BASIS OF ELIGIBILITY,

1999, 2001, 2002, 2003, 2004, AND 2005a,b,c

$69

$129$154

$31$12

$83

$174

$208

$28$16

$91

$193

$231

$32 $19

$100

$202

$257

$42 $22

$110

$229

$284

$48 $24

$114

$240

$295

$45 $25

$0

$50

$100

$150

$200

$250

$300

$350


1999 2001 2002 2003 2004 2005

54

54

54


Compendiums. aThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. bMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage. cMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility.

EXHIBIT 43

NUMBER OF NONDUAL MEDICAID BENEFICIARIES BY BASIS OF ELIGIBILITY, 1999, 2001, 2002, 2003, 2004, AND 2005a,b

23.3

0.3

3.55.3

14.2

28.7

0.3

3.7

8.5

16.2

32.0

0.3

3.9

9.8

17.9

34.0

0.3

4.1

10.1

19.6

35.5

0.3

4.2

10.3

20.7

35.6

0.3

4.3

10.2

20.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0


200520042003200220011999

40.0(million)

55

55

55

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table ND2 of the 1999, 2001, 2002, 2003, 2004, and 2005 Compendiums.

aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. bNondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 44

AVERAGE ANNUAL NUMBER OF MEDICAID PRESCRIPTION CLAIMS BY BASIS OF ELIGIBILITY,

NONDUAL BENEFICIARIES, 1999, 2001, 2002, 2003, 2004, AND 2005a,b

18.920.5 20.1 20.7

22.9 23.222.4

26.0 26.128.5 29.0 28.9

4.5 3.9 4.25.4 5.7 5.3

2.9 3.1 3.2 3.6 3.5 3.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

1999 2001 2002 2003 2004 2005

Aged Disabled Adults Children

56


aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. bNondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 45

AVERAGE ANNUAL MEDICAID PRESCRIPTION REIMBURSEMENT BY BASIS OF ELIGIBILITY,

NONDUAL BENEFICIARIES, 1999, 2001, 2002, 2003, 2004, AND 2005a,b,c,d

$805$1,020 $1,066

$1,201$1,374 $1,423

$1,312

$1,810$1,928

$2,243$2,457 $2,538

$175 $178 $201 $279 $316 $296$83 $119 $135 $169 $183 $193

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

1999 2001 2002 2003 2004 2005

ChildrenAdultsDisabledAged

57

57

57


aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. bNondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. cThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. dMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

EXHIBIT 46

AVERAGE MONTHLY MEDICAID PRESCRIPTION REIMBURSEMENT BY BASIS OF ELIGIBILITY,

NONDUAL BENEFICIARIES, 1999, 2001, 2002, 2003, 2004, AND 2005a,b,c,d

$86

$114 $123$133

$151 $157

$131

$178$197

$219$241 $249

$29 $27 $31 $40 $45 $43

$12 $16 $19 $22 $24 $25

$0

$50

$100

$150

$200

$250

1999 2001 2002 2003 2004 2005

Aged Disabled Adults Children

58


aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. bNondual beneficiaries include beneficiaries who were never dually eligible or were dually eligible but never had Medicaid FFS pharmacy benefits. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. cThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. dMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

EXHIBIT 47

NUMBER OF DUAL MEDICAID BENEFICIARIES BY BASIS OF ELIGIBILITY, 1999, 2001, 2002, 2003, 2004, AND 2005a,b

5.3

3.1

2.2

5.7

3.2

2.5

6.2

3.4

2.8

6.7

3.8

2.9

6.9

3.9

3.0

7.0

3.9

3.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

All Beneficiaries Aged Disabled

7.0(million)

1999 2001 2002 2003 2004 2005

59

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table D2 of the 1999, 2001, 2002, 2003, 2004, and 2005 Compendiums.

aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 48

AVERAGE ANNUAL NUMBER OF MEDICAID PRESCRIPTION CLAIMS BY BASIS OF ELIGIBILITY,

DUAL ELIGIBLE BENEFICIARIES, 1999, 2001, 2002, 2003, 2004, AND 2005a,b

34.639.3 40.1 40.6

43.6 44.5

35.440.3 40.9

44.9 46.7 46.7

0.0

10.0

20.0

30.0

40.0

50.0

1999 2001 2002 2003 2004 2005

Aged Disabled

60

60

60


aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 49

AVERAGE ANNUAL MEDICAID PRESCRIPTION REIMBURSEMENT BY BASIS OF ELIGIBILITY,

DUAL ELIGIBLE BENEFICIARIES, 1999, 2001, 2002, 2003, 2004, AND 2005a,b,c,d

$1,350

$1,834$1,994

$2,138$2,420 $2,534

$2,030

$2,698$2,885

$3,362

$3,731$3,886

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

1999 2001 2002 2003 2004 2005

Aged Disabled

61

61

61


aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. cThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states.

dMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

62

62

62

EXHIBIT 50

AVERAGE MONTHLY MEDICAID PRESCRIPTION REIMBURSEMENT BY BASIS OF ELIGIBILITY, DUAL ELIGIBLE BENEFICIARIES, 1999, 2001, 2002, 2003, 2004, AND 2005a,b,c,d

$132$179 $198 $207

$234 $246

$189

$250$275

$308$343 $356

$0

$50$100

$150

$200

$250

$300$350

$400

1999 2001 2002 2003 2004 2005

Aged Disabled


aMedicaid basis of eligibility is classified as: aged, disabled, adults, and children. The disabled group includes beneficiaries of any age who were determined to be eligible because of disability or blindness, and thus includes a large number of dual eligibles. The children’s group includes children receiving foster care and adoptive services. The total includes some beneficiaries with unknown basis of eligibility and some whose age categories are not consistent with basis of eligibility. bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. cThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. dMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

EXHIBIT 51

AVERAGE ANNUAL MEDICAID DRUG REIMBURSEMENT AMONG DUAL ELIGIBLE BENEFICIARIES

BY AGE GROUP AND DISABILITY STATUS, 1999, 2001, 2002, 2003, 2004, AND 2005a,b,c

$1,387

$1,892$2,062

$2,237$2,527 $2,648

$2,143

$2,822$3,007

$3,478$3,829 $3,963

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

1999 2001 2002 2003 2004 2005

Duals Aged 65 or Older Disabled Duals Younger than 65

63

63

63

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Supplemental Tables 1A and 1B of the 1999, 2001, 2002, 2003, 2004, and 2005 Compendiums.

aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status. bThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states. cMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

EXHIBIT 52

PERCENTAGE OF DUAL ELIGIBLE BENEFICIARIES WITH ANNUAL DRUG COSTS IN SPECIFIED RANGES,

1999, 2001, 2002, 2003, 2004, AND 2005a

53%

30%

16%

45%

30%25%

43%

29% 28%

42%

27%31%

39%

27%

35%38%

26%

35%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$1,000 or Less $1,001 to $3,000 $3,001 or More

1999 2001 2002 2003 2004 2005

64

64

64

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Supplemental Table 1 of the 1999, 2001, 2002, 2003, 2004, and 2005 Compendiums.

aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2005. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

EXHIBIT 53

NUMBER OF DUAL ELIGIBLE FULL-YEAR NURSING FACILITY RESIDENTS AND UNDER-AGE-65 DISABLED DUAL ELIGIBLE

BENEFICIARIES COMPARED TO ALL DUALS, 1999, 2001, 2002, 2003, 2004, AND 2005a

(million)

5.3

0.8

2.2

5.7

0.9

2.5

6.2

0.9

2.8

6.7

0.8

2.9

6.9

0.8

3.0

7.0

0.8

3.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

All Duals Full-Year Nursing Facility Residents Under-Age-65 Disabled Duals

7.0

1999 2001 2002 2003 2004 2005

65

65

65

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table 11 of the 1999 Compendium and Table D.2 of the 2001, 2002, 2003, 2004, and 2005 Compendiums.


EXHIBIT 54

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT FOR DUAL ELIGIBLE FULL-YEAR NURSING FACILITY RESIDENTS AND UNDER-AGE-65 DISABLED DUAL ELIGIBLE BENEFICIARIES

$157$181 $189

$211

$249 $250$233

$282 $275 $252

$316 $308 $283

$356 $343

$295

$377 $356

$0

$50

$100

$150

$200

$250

$300

$350

$400

All Duals Full Year Nursing Facility Residents Under-Age-65 Disabled Duals

1999 2001 2002 2003 2004 2005

COMPARED TO ALL DUALS, 1999, 2001, 2002, 2003, 2004, AND 2005a,b,c

66

66

66

bThe Medicaid pharmacy reimbursement amount is the amount Medicaid reimbursed pharmacies, including dispensing fees minus beneficiary copayment. Reimbursement amounts are gross amounts prior to the receipt of rebates from drug manufacturers to states.

Source: Medicaid Analytic Extract (MAX), 2005. This graph is based on the information contained in Table 13 of the 1999 and D.4 of the 2001, 2002, 2003, 2004, and 2005 Compendiums.


cMonthly reimbursement amounts were calculated by dividing the total reimbursement among all beneficiaries in the study population by the total number of benefit months of those beneficiaries. Benefit months are months during which beneficiaries had FFS pharmacy benefit coverage.

chartbook: medicaid pharmacy benefit use and reimbursement

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