chartbook: medicaid pharmacy benefit use and reimbursement ...€¦ · 1 chartbook: medicaid...

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CHARTBOOK: MEDICAID PHARMACY BENEFIT USE AND REIMBURSEMENT IN 2003

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 2003. 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 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 Age Groups and Total Pharmacy Reimbursement Exhibit 8: Average Monthly Medicaid Pharmacy Reimbursement, by Basis of Eligibility and Dual

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

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

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

Status Exhibit 12: Average Annual Prescription Drug Spending per Beneficiary, by Dual Eligibility Status Exhibit 13: Distribution of Dual Eligibility Status and Total Pharmacy Reimbursement

Medicaid Pharmacy Use and Reimbursement, Nondual Beneficiaries

Exhibit 14: Distribution of 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 Pharmacy Reimbursement and Users for Top 10 Drug Groups among Nondual Beneficiaries

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

2

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

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

Medicaid Pharmacy Use and Reimbursement, Dual Eligible Beneficiaries

Exhibit 20: Distribution of 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 Pharmacy Reimbursement and Users for Top 10 Drug Groups Among Dual

Eligibles Exhibit 23: Percentage of Pharmacy Reimbursement and Users for Top 7 Therapeutic Categories among

Dual Eligibles Exhibit 24: Distribution of Annual 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 Prescriptions among Dual Eligibles, by State Exhibit 28: Average Annual Pharmacy Reimbursement Amount per Beneficiary for Aged Dual

Eligibles, by State Exhibit 29: Average Annual Pharmacy Reimbursement Amount per Beneficiary for Under-Age-65

Disabled Dual Eligible Beneficiaries, by State Exhibit 30: Average Annual 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 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, and 2003

Overview Exhibit 34: Total Pharmacy Reimbursement, 1999, 2000, 2001, and 2003 Exhibit 35: Pharmacy Reimbursement as a Percentage of Costs on All Services, 1999, 2001, 2002, and

2003 Exhibit 36: Average Annual Prescription Drug Reimbursement per Medicaid Beneficiary, Nondual

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

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

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

Beneficiaries and Dual Eligibles 1999, 2001, 2002, and 2003

3

Exhibit 40: Brand Name and Generic Drugs as a Percentage of All Claims, 1999, 2001, 2002, and 2003 By Basis of Eligibility Exhibit 41: Number of Medicaid Beneficiaries by Basis of Eligibility, 1999, 2001, 2002, and 2003 Exhibit 42: Average Monthly Medicaid Pharmacy Reimbursement by Basis of Eligibiltiy, 1999, 2001,

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

2003 Exhibit 44: Average Annual Number of Prescription Claims by Basis of Eligibility, Nondual

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

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

Beneficiaries, 1999, 2001, 2002, and 2003 Dual Eligible Beneficiaries Exhibit 47: Number of Dual Medicaid Beneficiaries by Basis of Eligibility, 1999, 2001, 2002, and 2003 Exhibit 48: Average Annual Number of Prescription Claims by Basis of Eligibility, Dual Eligible

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

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

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

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

1999, 2001, 2002, and 2003 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, and 2003 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, and 2003

BENEFICIARY CHARACTERISTICS AND ILLUSTRATIVE USE AND REIMBURSEMENT MEASURES

5

EXHIBIT 1

DISTRIBUTION OF MEDICAID STUDY POPULATION BENEFICIARY CHARACTERISTICS, 2003

Percent of Beneficiaries

Beneficiary Characteristics

Among All Medicaid

Beneficiariesa

Among Nondual

Beneficiariesb Among Dual

Eligiblesb

Among Beneficiaries Who Resided in

Nursing Facilities All Yearc

Age 5 and younger 20 25 < 1 6–14 21 25 < 1 15–20 12 14 < 1 21–44 25 28 15 45–64 10 8 21 13e 65–74 5 1 25 13 75–84 4 < 1 24 31 85 and older 3 < 1 16 44

Sex Male 40 40 36 28 Female 60 59 64 72

Race African American 23 24 18 13 White 47 44 60 76 Other/Unknown 30 31 22 10

Dual Eligibility Statusb Dual Eligibles 16 0 100 92 Nondual Beneficiaries 84 100 0 8

Basis of Eligibilityd Children 48 58 < 1 < 1 Adults 25 30 1 < 1 Disabled 17 12 43 17 Aged 10 1 56 83

Number of Beneficiaries in Study Population 40,748,181 34,019,639 6,728,542 913,213 Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

EXHIBIT 1 (continued) ___________________________________________________________________________________

6

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 2003. Nondual beneficiaries include beneficiaries who were never 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 2003. 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.

7

EXHIBIT 2

ILLUSTRATIVE MEASURES OF STUDY POPULATION PHARMACY BENEFIT USE AND REIMBURSEMENT, 2003a

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) $33,513 $15,620 $17,893 $3,048

Average Annual Pharmacy Reimbursement per Beneficiaryc $822 $459 $2,659 $3,338

Average Pharmacy Reimbursement per Benefit Monthd $100 $59 $252 $327

Average Annual Number of Prescriptions per Beneficiary 13.1 7.3 42.3 64.2

Average Number of Prescriptions per Benefit Month 1.6 0.9 4.0 6.3 Source: Medicaid Analytic Extract (MAX), 2003. 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, 7.8 months of coverage. The comparable number was 7.3 months among nondual beneficiaries and 10.2 months among dual eligible beneficiaries, and 10.0 months among beneficiaries who resided in nursing facilities throughout their Medicaid enrollment in 2003. 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

9

EXHIBIT 3

DISTRIBUTION OF MEDICAID STUDY POPULATION BY AGE GROUP, NONDUAL AND DUAL ELIGIBLE BENEFICIARIES, 2003a

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

35%

1% 0%

35%

65%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

EXHIBIT 4

DISTRIBUTION OF MEDICAID STUDY POPULATION BY DISABILITY STATUS, NONDUAL AND DUAL ELIGIBLE BENEFICIARIES, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

88%

43%

57%

12%

0%

25%

50%

75%

100%

Disabled Non-disabled Disabled Non-disabledNondual Beneficiaries Dual Eligibles

11

EXHIBIT 5

DISTRIBUTION OF MEDICAID STUDY POPULATION BY RACE, NONDUAL AND DUAL ELIGIBLE BENEFICIARIES, 2003a


44%

31%

18%

60%

22%24%

0%

25%

50%

75%

100%

AfricanAmerican

W hite Other/Unknown AfricanAmerican

W hite Other/Unknown


MEDICAID PHARMACY REIMBURSEMENT AND USE, BY TYPE OF BENEFICIARY

13

EXHIBIT 6

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT, BY AGE GROUP, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. 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.

$21$32 $35

$98

$273

$214 $212$199

$100

$0

$50

$100

$150

$200

$250

$300

All 5 andYounger

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

Age

14

EXHIBIT 7

DISTRIBUTION OF AGE GROUPS AND TOTAL PHARMACY REIMBURSEMENT, 2003a

Source: Medicaid Analytic Extract (MAX), 2003. 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.

45 to 64

21 to 44

20 and Younger

53%

14%

26%

24%

10%

32%

11%

30%

0%

20%

40%

60%

80%

100%

Percent of Beneficiaries Percent of Pharmacy Reimbursement

65 and Older

15

EXHIBIT 8

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT, BY BASIS OF ELIGIBILITY AND DUAL STATUS, 2003a,b,c,d

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

Dual Status

$100

$22$42

$257

$202

$59

$252

$0

$50

$100

$150

$200

$250

$300

All Children Adults Disabled Aged NondualBeneficiaries

Dual Eligibles

Eligibility Status

16

EXHIBIT 9

PERCENTAGE OF BENEFICIARIES WITH AT LEAST ONE PRESCRIPTION DRUG CLAIM, BY DUAL ELIGIBILITY STATUS, 2003a


84%

56%

0%

25%

50%

75%

100%


17

EXHIBIT 10

AVERAGE ANNUAL NUMBER OF PRESCRIPTION DRUG CLAIMS PER BENEFICIARY, BY DUAL ELIGIBILITY STATUS, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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 2003 than dual eligible beneficiaries: 7.3 months for nonduals and 10.2 months for duals.

42.3

7.3

0

10

20

30

40

50


18

EXHIBIT 11

NUMBER OF PRESCRIPTIONS PER BENEFIT MONTH, BY BASIS OF ELIGIBILITY AND DUAL ELIGIBILITY STATUS, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

2.8

0.80.5

3.94.1

3.33.1

2.3

0

1

2

3

4

5

Aged Disabled Adults Children Aged Disabled Adults Children


19

EXHIBIT 12

AVERAGE ANNUAL PRESCRIPTION DRUG SPENDING PER BENEFICIARY, BY DUAL ELIGIBILITY STATUS, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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 2003 than dual eligible beneficiaries: 7.3 months for nonduals and 10.2 months for duals.

$2,659

$459

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000


20

EXHIBIT 13

DISTRIBUTION OF DUAL ELIGIBILITY STATUS AND TOTAL PHARMACY REIMBURSEMENT, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

17%

53%

83%

47%

0%

25%

50%

75%

100%

Percent of Beneficiaries Percent of Total Pharmacy Reimbursement

Dual

Nondual

MEDICAID PHARMACY USE AND REIMBURSEMENT, NONDUAL BENEFICIARIES

22

EXHIBIT 14

DISTRIBUTION OF BENEFICIARIES AND TOTAL PHARMACY REIMBURSEMENT AMONG NONDUAL BENEFICIARIES, BY BASIS OF ELIGIBILITY, 2003a,b,c

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

58%

21%

30%

18%

12%

58%

2%1%

0%

25%

50%

75%

100%


Adults

Children

Disabled

Aged

23

EXHIBIT 15

TOTAL ANNUAL MEDICAID REIMBURSEMENT FOR TOP 10 DRUG GROUPS AMONG NONDUAL BENEFICIARIES, 2003a,b,c,d

The top 10 drug groups (out of over 90 drug groups) accounted for 55 percent of total Medicaid FFS pharmacy reimbursement for nondual beneficiaries in 2003.

Source: Medicaid Analytic Extract (MAX), 2003. 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, 7.5 months of coverage. cThe top 10 drug groups were determined based on total Medicaid reimbursement in 2003. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/products/index.aspx?id=1] (November 8, 2006). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

$1,898

$1,085$986 $966 $950

$785$561 $508 $442 $441

$0

$400

$800

$1,200

$1,600

$2,000

Antipsy

choti

cs

Antide

pressa

nts

Antiast

hmati

c

Antico

nvuls

ant

Antivir

al

Ulcer D

rugs

Analge

sics -

Narc

otic

Antidia

betic

Analge

sics -

Anti

-infla

mmatory

Stimula

nts/A

nti-ob

esity/

Anorex

iants

($ million)

24

EXHIBIT 16

PERCENTAGE OF PHARMACY REIMBURSEMENT AND USERS FOR TOP 10 DRUG GROUPS AMONG NONDUAL BENEFICIARIES, 2003a,b,c,d

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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/products/index.aspx?id=1] (November 8, 2006). cThe top 10 drugs groups were determined based on total Medicaid reimbursement in the state for 2003. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/products/index.aspx?id=1] (November 8, 2006). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

1 2 %

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

1 0 %

1 7 %

4 %2 %

7 %

1 7 %

4 %

1 4 %

3 %

0 %

5 %

1 0 %

1 5 %

2 0 %

Antipsy

choti

cs

Antide

pressa

nts

Antiast

hmati

c

Antico

nvuls

ant

Antivir

al

Ulcer D

rugs

Analge

sics -

Narc

otic

Antidia

betic

Analge

sics -

Anti

-infla

mmatory

Stimula

nts/A

nti-ob

esity/

Anorex

iants

P ercen t o f N on d u a l B en efic ia ry P h arm acy R eim b u rsem en t P ercen t o f N on d u a l B en efic ia ries

25

EXHIBIT 17

PERCENTAGE OF PHARMACY REIMBURSEMENT AND USERS FOR TOP 7 THERAPEUTIC CATEGORIES AMONG NONDUAL BENEFICIARIES, 2003a,b,c,d

The top 7 therapeutic categories (out of 18 therapeutic categories) accounted for 76 percent of total Medicaid FFS pharmacy reimbursement for nondual beneficiaries in 2003

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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/products/index.aspx?id=1] (November 8, 2006). cTop 7 categories were determined based on total Medicaid reimbursement in 2003. For information about these therapeutic categories, see Wolters Kluwer Health, [http://www.medispan.com/products/index.aspx?id=1] (November 8, 2006). cDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

21%

14%11%

8% 7% 7% 7%

21%

7%

37%

12%

26%

7%

14%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Central NervousSystem Drugs

Anti-infectiveAgents

Respiratory Agents Analgesics andAnesthetics

CardiovascularAgents

Neurom uscularAgents

Endocrine/M etabolic Drugs

Percent of N ondual Beneficiary Pharmacy Reimbursement Percent of N ondual Beneficiaries

26

EXHIBIT 18

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT AMONG NONDUAL BENEFICIARIES, BY STATE, 2003a,b,c

Source:

Medicaid Analytic Extrac

t (MAX), 2003. This graph is based on the information contained in Table N.2 of the Compendium for the nation. The Compendium was prepared for 49 states (excluding Arizona) 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 2003. 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.

$12$33

$35$36

$38$39$40

$41$42$43$43$43$44$44$45$46

$47$48

$51$52$52$52

$55$57$57

$58$59$60

$65$66$66$66

$71$72$72

$75$77

$78$78$79

$81$84$84

$90$93$94

$123$130

$131$140

$204

$0 $30 $60 $90 $120 $150 $180 $210

NMARSCSD

MDOK

W YCAMIID

MSNDALVTCO

ILGALAMTUTAKTXNCNHORKS

USAME

INIAFL

W AW I

MATNVAOHNEKYPADE

MOW VNYMNNVNJHIRI

DCCT

27

EXHIBIT 19

GENERIC PRESCRIPTIONS AS PERCENTAGE OF ALL PRESCRIPTIONS AMONG NONDUAL BENEFICIARIES, BY STATE, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. This graph is based on the information contained in Table N.2 of the Compendium for the nation. The

Compendium was prepared for 49 states (excluding Arizona) 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/products/index.aspx?id=1] (November 8, 2006). bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

44.945.0

45.245.3

46.646.746.7

47.147.347.4

47.647.8

48.148.448.4

48.748.948.9

49.149.2

49.649.7

50.050.1

50.350.550.650.6

51.551.751.8

52.052.052.1

52.553.4

53.753.853.9

54.054.2

54.654.7

55.355.355.455.4

56.856.9

57.162.2

40.0 44.0 48.0 52.0 56.0 60.0 64.0

NJ NY M D SD KS SC DC CT LA AK TX PA GA NC VA M S M N

RI ND AR OH FL

WI USAAL WY M E NH CA NE KY M O DE IA

OK ID

TN WV M T VT IN

UT CO

IL M A M I

NV NM

HI WA OR

MEDICAID PHARMACY USE AND REIMBURSEMENT, DUAL ELIGIBLE BENEFICIARIES

29

EXHIBIT 20

DISTRIBUTION OF BENEFICIARIES AND TOTAL PHARMACY REIMBURSEMENT AMONG DUAL ELIGIBLES, BY BASIS OF ELIGIBILITY, 2003a,b,c,d

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

43%54%

56%45%

0%

20%

40%

60%

80%

100%


Disabled

Aged

30

EXHIBIT 21

TOTAL ANNUAL MEDICAID REIMBURSEMENT FOR TOP 10 DRUG GROUPS AMONG DUAL ELIGIBLES, 2003a,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 2003.

Source: Medicaid Analytic Extract (MAX), 2003. 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, nondual eligible Medicaid beneficiaries in the study population had, on average, 10.2 months of coverage. cThe top 10 drug groups were determined based on total Medicaid reimbursement in 2003. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/products/index.aspx?id=1] (November 8, 2006). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

($ million) $2,302

$1,375$1,177

$1,053 $1,000 $937$779 $761 $754

$641

$0

$400

$800

$1,200

$1,600

$2,000

$2,400

Antipsy

choti

c

Ulcer D

rugs

Antide

pressa

nts

Antihy

perlip

idemic

Antico

nvuls

ant

Antidia

betic

Antihy

perte

nsive

Analge

sics -

Anti

-infla

mmatory

Analge

sics -

Narc

otic

Antiast

hmati

c

31

EXHIBIT 22

PERCENTAGE OF PHARMACY REIMBURSEMENT AND USERS FOR TOP 10 DRUG GROUPS AMONG DUAL ELIGIBLES, 2003a,b,c,d

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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/products/index.aspx?id=1] (November 8, 2006). cThe top 10 drugs groups were determined based on total Medicaid reimbursement in the state for 2003. For information about these drug groups, see Wolters Kluwer Health, [http://www.medispan.com/products/index.aspx?id=1] (November 8, 2006). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

13%8% 7% 6% 6% 5% 4% 4% 4% 4%

24%

40% 41%

26%33%

44%

34%

50%

33%

22%

0%5%

10%15%20%25%30%35%40%45%50%55%

Antipsy

choti

c

Ulcer D

rugs

Antide

pressa

ntsAnti

hype

rlipide

mic

Antico

nvuls

ant

Antidia

betic

Antihy

perte

nsive

Analge

sics -

Anti

-infla

mmatory

Analge

sics -

Narc

otic

Antiast

hmati

c

Percent of Dual Eligible Pharmacy Reimbursement Percent of Dual Eligible Beneficiaries

32

EXHIBIT 23

PERCENTAGE OF PHARMACY REIMBURSEMENT AND USERS FOR TOP 7 THERAPEUTIC CATEGORIES AMONG DUAL ELIGIBLES, 2003a,b,c,d

The top 7 therapeutic categories (out of 18 therapeutic categories) accounted for 79 percent of total Medicaid FFS pharmacy reimbursement for dual beneficiaries in 2003

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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/products/index.aspx?id=1] (November 8, 2006). cTop 7 categories were determined based on total Medicaid reimbursement in 2003. For information about these therapeutic categories, see Wolters Kluwer Health, [http://www.medispan.com/products/index.aspx?id=1] (November 8, 2006). dDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

22%17%

10% 9% 8% 7% 7%

48%

61%

40%

50%

41%

26%

51%

0%

25%

50%

75%

100%

Central NervousSystem Drugs

CardiovascularAgents

GastrointestinalAgents

Analgesics andAnesthetics

Endocrine/M etabolic Drugs

NeromuscularAgents

Anti-infectiveAgents

Percent of Dual Eligible Pharmacy Reimbursement Percent of Dual Eligible Beneficiaries

33

40%

3%

42%

5%

37%

28%

45%

53%

16%

31%

11%

32%

8%

38%

10%2%

0%

20%

40%

60%

80%

100%

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

EXHIBIT 24

DISTRIBUTION OF ANNUAL PHARMACY REIMBURSEMENT FOR DUAL ELIGIBLES, UNDER-AGE-65 DISABLED VS. AGE 65 AND OLDER, 2003a,b,c

Source: Medicaid Analytic Extract (MAX), 2003. 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, 10.2 months of coverage in 2003. cDual eligibles include beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefit coverage during any month of Medicaid enrollment in 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

$10,000 and more

Disabled Dual Eligibles Under Age 65

Dual Eligibles Age 65 and Older

$1,000 to $5,000

$0 to $1,000

$5,001 to $10,000

$0 to $1,000

$1,000 to $5,000

$5,001 to $10,000

$10,000 and more

(Total Benes = 2.3 million) (Total Exp. = $7.9 billion) (Total Benes = 4.3 million) (Total Exp. = $9.6 billion)

34

EXHIBIT 25

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT AMONG DUAL ELIGIBLES, BY BENEFICIARY NURSING FACILITY RESIDENCE, 2003a,b,c

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

$252

$316

$295

$239

$150

$175

$200

$225

$250

$275

$300

$325

All Duals Dual All-Year NF Residents Dual Part-Year NF Residents Dual W ith No NF Use

35

EXHIBIT 26

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT AMONG DUAL ELIGIBLES, BY STATE, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. This graph is based on the information contained in Table N.5 of the Compendium for the nation. The

Compendium was prepared for 49 states (excluding Arizona) 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 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

$152$156

$177$196

$198$200

$206$212$212

$216$219

$227$230

$231$233

$235$239

$249$250

$252$254

$256$259

$263$266$266$267

$270$271

$278$281

$283$283$284

$286$288

$294$295$295

$306$307

$317$320$321

$324$327

$331$334

$339$359

$386

$150 $175 $200 $225 $250 $275 $300 $325 $350 $375 $400 $425

ILSCAR

NMDEOKM SHI

W ITXALVT

M DM I

GAM ACANDORUS

M EW VW ACONYLARI

SDNCKYFLIA

M TVAKS

W YNEIN

M NID

NVTNPANHDCCTNJ

OHM OAKUT

36

EXHIBIT 27

GENERIC PRESCRIPTIONS AS A PERCENTAGE OF ALL PRESCRIPTIONS AMONG DUAL ELIGIBLES, BY STATE, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. This graph is based on the information contained in Table N.5 of the Compendium for the nation. The Compendium was prepared for 49 states (excluding Arizona) 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/products/index.aspx?id=1] (November 8, 2006). bDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

41.843.3

43.946.546.6

46.746.7

47.147.7

48.649.249.2

49.649.749.749.849.949.950.050.0

50.350.4

50.751.051.0

51.251.851.851.851.8

52.552.652.752.7

52.953.053.053.0

53.453.4

53.954.254.254.3

54.955.6

55.855.956.0

56.961.0

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

NYAKNJ

MDSCTXCADCNCCTPARIFLSDUTLAVAOH

USAMNNHMSWYKSHI

GAVTTNMEND

ILDE

MOID

NMWINEIN

ARNVCOMTIA

KYOKMAWAAL

WVMIOR

Percentage

37

EXHIBIT 28

AVERAGE ANNUAL PHARMACY REIMBURSEMENT AMOUNT PER BENEFICIARY FOR AGED DUAL ELIGIBLES, BY STATE, 2003a,b,c

Source: Medicaid Analytic Extract (MAX), 2003. This graph is based on the information contained in State Tables D.3 of the Compendium. The Compendium was prepared for 49 states (excluding Arizona) 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, 10.1 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 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

$811$1,297

$1,324$1,342

$1,576$1,648

$1,776$1,851

$1,899$1,926

$1,946$1,949$1,956

$1,987$1,990

$2,001$2,025

$2,138$2,153$2,162

$2,208$2,250

$2,266$2,271$2,272

$2,289$2,315$2,319

$2,360$2,413

$2,538$2,541

$2,580$2,584$2,588$2,598$2,600

$2,636$2,669

$2,680$2,690$2,691$2,699

$2,732$2,792$2,797$2,797

$2,848$2,894

$2,963$2,995

$750 $1,000 $1,250 $1,500 $1,750 $2,000 $2,250 $2,500 $2,750 $3,000

ILDCMNSCWI

NMHI

ORMAMDVTMINYOKNVCAARUSMSCOALFL

NDGATXRI

WAMTMEUTNEIAID

AKWY

INWVKSVATNSDDENHNCNJPAKYCT

MOLAOH

38

EXHIBIT 29

AVERAGE ANNUAL PHARMACY REIMBURSEMENT AMOUNT PER BENEFICIARY FOR UNDER-AGE-65 DISABLED DUAL ELIGIBLE BENEFICIARIES, BY STATE, 2003a,b,c

Source: Medicaid Analytic Extract (MAX), 2003. This graph is based on the information contained in State Tables D.3 of the Compendium. The Compendium was prepared for 49 states (excluding Arizona) 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, 10.5 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 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

$1,750$2,311

$2,359$2,454

$2,502$2,504

$2,623$2,654

$2,739$2,825$2,835$2,844

$2,893$2,959

$3,016$3,045$3,054

$3,136$3,176$3,180

$3,200$3,201

$3,297$3,298$3,307$3,313

$3,358$3,362

$3,380$3,403

$3,423$3,478

$3,499$3,515$3,524

$3,649$3,652

$3,670$3,671

$3,805$3,846$3,858

$3,927$4,017

$4,043$4,093

$4,173$4,236

$4,310$4,520

$5,051

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

AROKMSNMTXALSCGAMINDWVLADCOR

MAKYSDNVMD

ILHI

VTMEMTPAWINCUS

WAKSCA

WYRIIA

VANECOIN

MNUTFLID

NYOHNHTNDENJ

MOCTAK

39

EXHIBIT 30

AVERAGE ANNUAL PHARMACY REIMBURSEMENT AMOUNT PER BENEFICIARY FOR DUAL ELIGIBLE ALL-YEAR NURSING FACILITY RESIDENTS, BY STATE, 2003a,b,c

Source: Medicaid Analytic Extract (MAX), 2003. This graph is based on the information contained in State Tables D.3 of the Compendium. The Compendium was prepared

for 49 states (excluding Arizona) 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, 10.0 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 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

$598$1,012

$1,269$1,983

$2,150$2,603$2,619$2,619

$2,803$2,808

$3,000$3,023$3,041$3,053

$3,078$3,106$3,111

$3,165$3,177$3,179

$3,209$3,218$3,220

$3,244$3,250

$3,316$3,317$3,319

$3,353$3,384$3,387

$3,442$3,510$3,517

$3,541$3,560

$3,686$3,723$3,741

$3,797$3,818

$3,848$3,870$3,870

$3,963$3,981

$4,018$4,076

$4,193$4,598

$5,189

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

DCNYSCHI

MNORMI

MANVVTNDWADE

NMMTMECAKSCOWI

USAAR

WVIAFL

WYALNEID

GANHSDRI

MDTNCTOK

ILVAINNJ

OHMSPANCUTTX

MOKYLAAK

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

41

EXHIBIT 31

PERCENTAGE OF MEDICAID BENEFICIARIES USING AT LEAST ONE DRUG EXCLUDED FROM MEDICARE PART D, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

27%

73% 47%

53%

Dual Eligibles 6,653,769

Nondual Beneficiaries 33,924,633

At Least 1 Drug

Excluded from Part D

No Drugs Excluded from

Part D

No Drugs Excluded from

Part D

At Least 1 Drug

Excluded from Part D

42

42

42

EXHIBIT 32

ANNUAL MEDICAID PHARMACY REIMBURSEMENT FOR DRUGS EXCLUDED FROM MEDICARE PART D,

NONDUAL AND DUAL ELIGIBLE BENEFICIARIES, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

$169$134

$43$60

$35$58

$244

$490

$22

$68$106

$70 $70

$349

$108

$15

$196

$113

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

$500

Anorexia orWeight

Loss/Gain

Fertility Drugs Drugs forCosmeticPurposes

Cough and ColdMedications

Vitamins andMinerals

Non-prescription

Drugs

Barbiturates Benzodiazepines Other Part DExcl Rx Drugs


43

43

43

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, 2003a,b

Source: Medicaid Analytic Extract (MAX), 2003. 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 2003. 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.

1.3%

1.1%

0.4%

0.7%

0.3%

0.0%

0.8%

0.0%0.0%0.0%

0.9%

0.7%

0.0%

0.3%0.3%

0.0%0.0%0.0%0.0%

0.3%

0.6%

0.9%

1.2%

1.5%

Anorexia orWeight

Loss/Gain

Fertility Drugs Drugs forCosmeticPurposes

Cough and ColdMedications

Vitamins andMinerals

Non-prescription

Drugs

Barbiturates Benzodiazepines Other Part DExcl Rx Drugs


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

45

EXHIBIT 34

TOTAL PHARMACY REIMBURSEMENT, 1999, 2001, 2002, AND 2003a,b

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

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.

(million)

$15,588

$22,910

$27,064

$33,513

$0

$10,000

$20,000

$30,000

$40,000

1999 2001 2002 2003

46

46

46

EXHIBIT 35

PHARMACY REIMBURSEMENT AS A PERCENTAGE OF COSTS OF ALL SERVICES, 1999, 2001, 2002, AND 2003a,b,c

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

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 2003 (DE, IA, 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. As a result, pharmacy reimbursement as a percentage of the costs of all Medicaid services is higher in 2003 than it would otherwise be.

12% 15% 15% 17%

0%

25%

50%

75%

100%

1999 200 1 2002 2 003

47

47

47

EXHIBIT 36

AVERAGE ANNUAL PRESCRIPTION DRUG REIMBURSEMENT PER MEDICAID BENEFICIARY, NONDUAL BENEFICIARIES AND DUAL ELIGIBLES, 1999, 2001, 2002, AND 2003a,b,c

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

Compendiums. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

$ 2 9 8 $ 3 6 2 $ 3 8 5 $ 4 5 9

$ 1 , 6 2 9

$ 2 , 2 0 3$ 2 , 3 8 7

$ 2 , 6 5 9

$ 0

$ 5 0 0

$ 1 , 0 0 0

$ 1 , 5 0 0

$ 2 , 0 0 0

$ 2 , 5 0 0

$ 3 , 0 0 0

1 9 9 9 2 0 0 1 2 0 0 2 2 0 0 3

N o n d u a l B e n e f ic ia r ie s D u a l E l ig ib le s

48

48

48

EXHIBIT 37

AVERAGE MONTHLY PHARMACY REIMBURSEMENT PER BENEFICIARY, NONDUAL BENEFICIARIES AND DUAL ELIGIBLES, 1999, 2001, 2002, AND 2003a,b,c


Compendiums. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

$ 4 1 $ 4 8 $ 5 2 $ 5 9

$ 1 5 7

$ 2 1 1$ 2 3 3

$ 2 5 2

$ 0$ 2 0$ 4 0$ 6 0$ 8 0

$ 1 0 0$ 1 2 0$ 1 4 0$ 1 6 0$ 1 8 0$ 2 0 0$ 2 2 0$ 2 4 0$ 2 6 0

1 9 9 9 2 0 0 1 2 0 0 2 2 0 0 3

N o n d u a l B e n e f ic ia r ie s D u a l E l ig ib le s

49

49

49

EXHIBIT 38

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

ELIGIBLES, 1999, 2001, 2002, AND 2003a


Compendiums. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

5 5 %5 2 % 5 3 %

5 6 %

8 4 % 8 6 % 8 5 % 8 4 %

0 %

2 0 %

4 0 %

6 0 %

8 0 %

1 0 0 %

1 9 9 9 2 0 0 1 2 0 0 2 2 0 0 3

N o n d u a l B e n e fic ia rie s D u a l E lig ib le s

50

50

50

EXHIBIT 39

AVERAGE ANNUAL NUMBER OF PRESCRIPTION CLAIMS PER MEDICAID BENEFICIARY, NONDUAL BENEFICIARIES AND DUAL ELIGIBLES, 1999, 2001, 2002, AND 2003a


Compendiums.

aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

6 .4 6 .4 6 .5 7 .3

3 4 .8

3 9 .6 4 0 .24 2 .3

0 .0

5 .0

1 0 .0

1 5 .0

2 0 .0

2 5 .0

3 0 .0

3 5 .0

4 0 .0

4 5 .0

1 9 9 9 2 0 0 1 2 0 0 2 2 0 0 3

N o nd ua l B en e fic ia rie s D ua l E lig ib le s

51

51

51

EXHIBIT 40

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

Source: Medicaid Analytic Extract (MAX), 2003. These graph are based on the information contained in Table 5 of the Compendium. 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/products/index.aspx?id=1] (November 8, 2006).

Brand Name

Generic

Brand Name

Generic

53%

47%

50%

50%

47%

53%

Brand Name

Generic

Brand Name

50%

50%

1999 2001 2002 2003

Generic

52

52

52

EXHIBIT 41

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

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

28.6

3.35 .7 5 .3

14.2

34.4

3.4

6.18.6

16.2

38.2

3.6

6.7

9.9

17.9

40 .7

4 .1

6 .9

10.1

19.6

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

A ll B eneficiaries A ged D isabled A dults Children

1999 2001 2002 2003

(million)

53

53

53

EXHIBIT 42

AVERAGE MONTHLY MEDICAID PHARMACY REIMBURSEMENT BY BASIS OF ELIGIBILITY, 1999, 2001, 2002, AND 2003a,b,c

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

$69

$129$154

$31$12

$83

$174

$208

$28$16

$91

$193

$231

$32$19

$100

$202

$257

$42$22

$0

$50

$100

$150

$200

$250

$300

All Beneficiaries Aged Disabled Adults Children

1999 2001 2002 2003

54

54

54

EXHIBIT 43

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

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

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

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

All B eneficiaries Aged D isabled Adults C hildren

1999 2001 2002 2003

(million)

55

55

55

EXHIBIT 44

AVERAGE ANNUAL NUMBER OF PRESCRIPTION CLAIMS BY BASIS OF ELIGIBILITY, NONDUAL BENEFICIARIES,

1999, 2001, 2002, AND 2003a,b


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.

18.920.5 20.1 20.7

22.4

26.0 26.128.5

4.5 3.9 4.25.4

2.9 3.1 3.2 3.6

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

1999 2001 2002 2003

Aged Disabled Adults Children

56

56

56

EXHIBIT 45

AVERAGE ANNUAL PRESCRIPTION REIMBURSEMENT BY BASIS OF ELIGIBILITY, NONDUAL BENEFICIARIES, 1999, 2001, 2002, AND 2003a,b,c,d


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.

$ 8 0 5

$ 1 , 0 2 0 $ 1 , 0 6 6$ 1 , 2 0 1

$ 1 , 3 1 2

$ 1 , 8 1 0$ 1 , 9 2 8

$ 2 , 2 4 3

$ 1 7 5 $ 1 7 8 $ 2 0 1$ 2 7 9

$ 8 3 $ 1 1 9 $ 1 3 5 $ 1 6 9

$ 0

$ 5 0 0

$ 1 , 0 0 0

$ 1 , 5 0 0

$ 2 , 0 0 0

$ 2 , 5 0 0

1 9 9 9 2 0 0 1 2 0 0 2 2 0 0 3

A g e d D i s a b l e d A d u l t s C h i l d r e n

57

57

57

EXHIBIT 46

AVERAGE MONTHLY PRESCRIPTION REIMBURSEMENT BY BASIS OF ELIGIBILITY, NONDUAL BENEFICIARIES, 1999,

2001, 2002, AND 2003a,b,c,d


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.

$ 8 6

$ 1 1 4$ 1 2 3

$ 1 3 3$ 1 3 1

$ 1 7 8

$ 1 9 7

$ 2 1 9

$ 2 9 $ 2 7 $ 3 1$ 4 0

$ 1 2 $ 1 6 $ 1 9 $ 2 2

$ 0

$ 5 0

$ 1 0 0

$ 1 5 0

$ 2 0 0

$ 2 5 0

1 9 9 9 2 0 0 1 2 0 0 2 2 0 0 3

A g e d D i s a b l e d A d u l t s C h i l d r e n

58

58

58

EXHIBIT 47

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

Source: Medicaid Analytic Extract (MAX), 2003. This graph is based on the information contained in Table D2 of the 1999, 2001, 2002, and 2003 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 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

5.3

3.1

2.2

5.7

3.2

2.5

6.2

3.4

2.8

6.7

3.8

2.9

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

All Beneficiaries Aged Disabled

1999 2001 2002 2003

(million)

59

59

59

EXHIBIT 48

AVERAGE ANNUAL NUMBER OF PRESCRIPTION CLAIMS BY BASIS OF ELIGIBILITY, DUAL ELIGIBLE BENEFICIARIES, 1999, 2001, 2002, AND 2003a,b


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 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

3 4 .6

3 9 .3 4 0 .1 4 0 .6

3 5 .4

4 0 .3 4 0 .9

4 4 .9

0 .0

1 0 .0

2 0 .0

3 0 .0

4 0 .0

5 0 .0

1 9 9 9 2 0 0 1 2 0 0 2 2 0 0 3

A g e d D is a b le d

60

60

60

EXHIBIT 49

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


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 2003. 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.

$1,350

$1,834$1,994

$2,138$2,030

$2,698$2,885

$3,362

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

1999 2001 2002 2003

Aged Disabled

61

61

61

EXHIBIT 50

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


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 2003. 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.

$132

$179$198 $207

$189

$250

$275

$308

$0

$50

$100

$150

$200

$250

$300

$350

1999 2001 2002 2003

Aged Disabled

62

62

62

EXHIBIT 51

AVERAGE ANNUAL DRUG REIMBURSEMENT AMONG DUAL ELIGIBLE BENEFICIARIES BY AGE GROUP AND DISABILITY STATUS, 1999, 2001, 2002, AND 2003a,b,c

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

aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

$1,387

$1,892$2,062

$2,237$2,143

$2,822$3,007

$3,478

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

1999 2001 2002 2003

Duals Aged 65 or Older Disabled Duals Younger than 65

63

63

63

EXHIBIT 52

PERCENTAGE OF DUAL ELIGIBLE BENEFICIARIES WITH ANNUAL DRUG COSTS IN SPECIFIED RANGES, 1999, 2001, 2002, AND 2003a

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

aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

53%

30%

16%

45%

30%25%

43%

29% 28%

42%

27%31%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

$1,000 or Less $1,001 to $3,000 $3,001 or M ore

1999 2001 2002 2003

64

64

64

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, AND 2003a

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

the 2001, 2002, and 2003 Compendiums. aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. Refer to Table 1 in the Compendium for more information about how we determined dual eligibility status.

(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

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

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

1999 2001 2002 2003

65

65

65

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, AND 2003a,b,c

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

aDual eligibles are beneficiaries who had Medicare as well as Medicaid FFS pharmacy benefits during any month of Medicaid enrollment in 2003. 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.

$157

$181$189

$211

$249$233

$282 $275

$252

$316$308

$250

$0

$50

$100

$150

$200

$250

$300

$350

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

1999 2001 2002 2003

chartbook: medicaid pharmacy benefit use and reimbursement ...€¦ · 1 chartbook: medicaid...

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