Medicaid Program Expenditure Analysis and Trends Report
Explore detailed insights into Medicaid program expenditures, participant demographics, top drug classes, and pharmacy expenditures from September 2022. Understand the distribution of enrollees, expenditure breakdown by service, and trends in FY20-FY23. Discover data on Medicaid expansion, claim counts, and top drug classes in FY2021, FY2022, and FYTD2023.
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http://www.nmcfamilyresourcecenter.com/images/dss.gif MO HEALTHNET PHARMACY PROGRAM AND BUDGET UPDATE RARE DISEASE ADVISORY COMMITTEE NOVEMBER 08, 2022 ELIZABETH SHORT, PROGRAM SPECIALIST
September 2022 Enrollees and Expenditures Other (Children, Custodial Parents, Pregnant Women) 55% Other (Children,Custodial Parents, Pregnant Women) 82% Elderly 3% Disabled 42% Elderly 6% Disabled 12% Sept 2022 Enrollees Total=1,387,702 Sept 2022 Expenditures Total=$439,095,893 2
JULY-SEPT 2022 MO HEALTHNET EXPENDITURES BY SERVICE Nursing Facilities 8.86% Managed Care Premiums 31.20% Hospitals 10.11% Dental Services 0.05% Pharmacy 13.45% EPSDT Services 0.95% Part D Copays 0.02% Physician Related 3.53% In-Home Services 8.86% Rehab & Spec Svcs 2.13% State Institutions 1.28% Mental Health Services 16.95% Buy-In Premiums 2.62% 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 $4,000,000,000 $3.3b $2,000,000,000 $1.5b $1.4b $1.3b $439.1m $0 FY20 FY21 FY22 FYTD23 Total Medicaid Expenditures Total Pharmacy Expenditures 4
MEDICAID EXPANSION September 2022 PARTICIPANTS 260,132 EXPENDITURES $26,015,090 CLAIM COUNT 218,075 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) $29,579,181 3,807 Paliperidone Palmitate(Invega) $20,676,480 7,453 Biktarvy(HIV) $17,384,640 5,528 Lurasidone HCL(Latuda) $15,640,214 12,628 6
PHARMACY EXPENDITURES JULY -OCT 2022 $200,000,000 $175,617,923 35 day cycle $180,000,000 $156,682,201 28 day cycle $154,658,432 31 day cycle $160,000,000 $139,439,553 28 day cycle $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-OCT 2022 $120,000,000 $110,681,212 $100,000,000 $99,677,360 $99,728,058 $86,807,860 $80,000,000 $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 $4,000,000 $3,500,000 $3,000,000 $2,500,000 FY19 Total Spend $2,000,000 FY20 Total Spend FY21 Total Spend $1,500,000 FY22 Total Spend FY23 Total Spend $1,000,000 $500,000 $0 Dec Nov Jan Mar Feb July June Apr May Oct Sept Aug 9
CY2022 PUPM Drug Claim Reimbursement $250 $200 Children $150 Custodial Parents Elderly Indep Foster Care Child Persons with Disabilities Pregnant Women $100 Expansion $50 $0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 11
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 12
