Healthnet Pharmacy Program and Budget Update - October 2022 Insights
Explore key data regarding MO Healthnet Pharmacy Program and Budget Update for October 2022, including enrollees, expenditures, service breakdown, Medicaid expansion details, top drug classes, and pharmacy expenditures for July to November 2022.
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http://www.nmcfamilyresourcecenter.com/images/dss.gif MO HEALTHNET PHARMACY PROGRAM AND BUDGET UPDATE MHD DRUG PA COMMITTEE DECEMBER 15, 2022 ELIZABETH SHORT, PROGRAM SPECIALIST
October 2022 Enrollees and Expenditures Other (Children, Custodial Parents, Pregnant Women) 56% Other (Children,Custodial Parents, Pregnant Women) 82% Elderly 3% Disabled 42% Elderly 6% Disabled 12% Oct 2022 Enrollees Total=1,407,961 July-Oct 2022 Expenditures Total=$579,578,444 2
JULY-OCT 2022 MO HEALTHNET EXPENDITURES BY SERVICE Nursing Facilities 8.78% Hospitals 10.37% Managed Care Premiums 31.69% Dental Services 0.05% Pharmacy 13.25% EPSDT Services 0.94% Part D Copays 0.02% Physician Related 3.48% In-Home Services 8.80% Rehab & Spec Svcs 2.11% State Institutions 1.45% Mental Health Services 16.48% Buy-In Premiums 2.59% 3
FY20-FY23 EXPENDITURES $12,000,000,000 $11.1b $10.0b $10,000,000,000 $9.4b $8,000,000,000 $6,000,000,000 $4.3b $4,000,000,000 $2,000,000,000 $1.5b $1.4b $1.3b $579.5m $0 FY20 FY21 FY22 FYTD23 Total Medicaid Expenditures Total Pharmacy Expenditures 4
MEDICAID EXPANSION October 2022 PARTICIPANTS 274,164 EXPENDITURES $29,144,375 CLAIM COUNT 243,258 5
TOP 4 DRUG CLASSES PER FY FY2021 Expenditures FY2021 Claim Count Paliperidone Palmitate(Invega) $50,783,647 19,191 Adalimumab(Humira) $47,631,914 6,928 Lurasidone HCL(Latuda) $40,962,690 34,399 Methylphenidate HCL(ADHD) $32,590,476 121,636 FY2022 Expenditures FY2022 Claim Count Adalimumab(Humira) $65,085,308 8,983 Paliperidone Palmitate(Invega) $55,188,350 20,453 Lurasidone HCL(Latuda) $43,154,241 35,334 Methylphenidate HCL(ADHD) $35,358,173 130,708 FYTD2023 Expenditures FYTD2023 Claim Count Adalimumab(Humira) $38,191,407 4,959 Paliperidone Palmitate(Invega) $26,948,969 9,741 Biktarvy(HIV) $23,628,453 7,427 Lurasidone HCL(Latuda) $20,402,908 16,486 6
PHARMACY EXPENDITURES JULY -NOV 2022 $195,076,483 35 day cycle $175,617,923 35 day cycle $200,000,000 $156,682,201 28 day cycle $180,000,000 $154,658,432 31 day cycle $139,439,553 28 day cycle $160,000,000 $140,000,000 $120,000,000 $100,000,000 $80,000,000 $60,000,000 $40,000,000 $20,000,000 $0 7
PHARMACY SPECIALTY AND NON-SPECIALTY JULY-NOV 2022 $140,000,000 $124,126,808 $120,000,000 $110,681,212 $100,000,000 $99,677,360 $99,728,058 $80,000,000 $86,807,860 $70,949,675 $64,936,712 $60,000,000 $57,004,841 $54,930,374 $52,631,693 $40,000,000 $20,000,000 $0 Non-Specialty Paid Amount Specialty Paid Amount 8
MAVYRET EXPENDITURES $4,500,000 $4,000,000 $3,500,000 $3,000,000 $2,500,000 FY19 Total Spend FY20 Total Spend $2,000,000 FY21 Total Spend FY22 Total Spend $1,500,000 FY23 Total Spend $1,000,000 $500,000 $0 Dec Nov Jan Mar Feb July June Apr May Oct Sept Aug 9
FY2020-FYTD 2023 Rare Disease Expenditures Per Day $500,000 $400,000 $300,000 $200,000 $100,000 $0 July Aug Sept Oct Nov Dec Jan Feb Mar AprilMay June FY2020 Rare Disease Spend FY2021 Rare Disease Spend FY2022 Rare Disease Spend FYTD2023 Rare Disease Spend 11
