Overview of MO Healthnet Pharmacy Program and Budget Update
This content provides details on the MO Healthnet Pharmacy Program and Budget Update for July-August 2023, including enrollees, expenditures, pharmacy spend, specialty vs. non-specialty pharmacy expenses, and AEG expenditures per participant count.
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http://www.nmcfamilyresourcecenter.com/images/dss.gif MO HEALTHNET PHARMACY PROGRAM AND BUDGET UPDATE MISSOURI PHARMACY ADVISORY BOARDS OCTOBER 2023 ELIZABETH SHORT, PROGRAM SPECIALIST
July-Aug 2023 Enrollees and Expenditures Other (Children, Custodial Parents, Pregnant Women) 63% Other (Children,Custodial Parents, Pregnant Women) 84% Elderly 3% Disabled 34% Elderly 5% Disabled 11% Aug 2023 Enrollees Total=1,486,027 July-Aug 2023 Expenditures Total=$364,404,781 2
JULY-AUG 2023 MO HEALTHNET EXPENDITURES BY SERVICE Nursing Facilities 7.96% Hospitals 9.29% Managed Care Premiums 34.19% Dental Services 0.09% Pharmacy 13.65% Part D Copays 0.01% Physician Related 2.96% In-Home Services 8.14% Rehab & Spec Svcs 1.93% EPSDT Services 1.11% State Institutions 1.13% Mental Health Services 17.45% Buy-In Premiums 2.06% 3
FY24 Pharmacy Spend vs Total Medicaid Spend Total Spend $2,669,625,105 July-Aug 2023 $364.4m 13.65% All Other Spend TOTAL PHARMACY SPEND $2.3b 86.35% 4
PHARMACY EXPENDITURES JULY-SEPT 2023 $250,000,000 $213,653,544 35 day cycle $171,420,385 28 day cycle $184,269,376 30 day cycle $200,000,000 $150,000,000 $100,000,000 $50,000,000 $0 5
PHARMACY SPECIALTY AND NON-SPECIALTY JULY -SEPT 2023 $160,000,000 $137,179,848 35 day cycle $140,000,000 $120,000,000 $117,781,163 30 day cycle $109,857,746 28 day cycle $100,000,000 $76,473,696 35 day cycle $80,000,000 $61,562,639 28 day cycle $60,000,000 $66,488,213 30 day cycle $40,000,000 $20,000,000 $0 Non-Specialty Paid Amount Specialty Paid Amount 6
FY22-FY24(JULY/AUG) AEG EXPENDITURES/PARTICIPANT COUNT Total AEG Expenditures Total AEG Participants $70,000,000 400,000 $62,351,367 350,795 349,933 350,000 $60,000,000 300,000 $53,487,361 $50,000,000 250,000 $40,000,000 200,000 $30,000,000 150,000 $20,000,000 100,000 $10,000,000 50,000 $0 0 Total AEG Expenditures FY22 Total AEG Expenditures FY23 Total AEG Participants FY22 Total AEG Participants FY23 Total AEG Expenditures FY24 Total AEG Participants FY24 7
MAVYRET EXPENDITURES $6,000,000 $5,000,000 $4,000,000 FY20 Total Spend $3,000,000 FY21 Total Spend FY22 Total Spend FY23 Total Spend $2,000,000 FY24 Total Spend $1,000,000 $0 8
TOP 10 HICL DRUG CLASSES FOR FYTD 2024 FYTD2024 Expenditures DRUG ADALIMUMAB(Humira) $29,656,224 TRULICITY(Diabetes) $21,405,544 BIKTARVY(HIV) $20,340,812 PALIPERIDONE PALMITATE(Invega) INSULIN ASPART(Diabetes) $18,951,007 $10,921,546 TRIKAFTA(Cystic Fibrosis) $10,634,089 METHYLPHENIDATE HCL(Stimulant)(Ritalin) MAVYRET(Hep C) $10,303,299 $10,287,748 BUDESONIDE/FORMOTEROL FUMARATE(Asthma) OTHER $10,052,396 9 $9,748,593
FY2020-FY2024 Rare Disease Expenditures Per Day $500,000 $450,000 $400,000 $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $0 FY2020 Rare Disease Spend FY2021 Rare Disease Spend FY2022 Rare Disease Spend FY2023 Rare Disease Spend FY2024 Rare Disease Spend 10
