Tropical Journal of Pharmaceutical Research

Original Research Article | OPEN ACCESS

Trends in Medicaid fee-for-service outpatient drug utilization, expenditures, and pharmacy reimbursement rates (2010â€“2012)

Bander Balkhi¹ , Abdulrahman Alshehri²

¹Pharmacoeconomic Research Unit, King Saud University, College of Pharmacy, Riyadh, Saudi Arabia; ²Security Forces Hospital Program, Riyadh, Saudi Arabia.

For correspondence:- Bander Balkhi Email: bbalkhi@ksu.edu.sa

Accepted: 15 January 2018 Published: 28 February 2018

Citation: Balkhi B, Alshehri A. Trends in Medicaid fee-for-service outpatient drug utilization, expenditures, and pharmacy reimbursement rates (2010â€“2012). Trop J Pharm Res 2018; 17(2):325-329 doi: 10.4314/tjpr.v17i2.18

© 2018 The authors.
This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited..

Abstract

Purpose: To assess drug utilization and expenditure trends in Medicaid fee-for-service program during the period 2010 – 2012 in the United States of America.

Methods: A retrospective, descriptive analysis of the trend in drug utilization and expenditures in the Medicaid fee-for-service (FFS) program was performed using Medicaid state drug utilization data provided by Centers for Medicare and Medicaid Services (CMS) in the United States. Descriptive analyses were performed for all variables in the study. Association between prescription-drug utilization and reimbursement rate was examined using a linear regression model.

Results: The results indicate that prescription-drug utilization of Medicaid FFS program decreased by 20 % during the period (2010 – 2012) as also drug expenditure during the same period. Although constituting nearly 70 % and about 75 % of the total drug utilization in 2010 and 2012, respectively, generics represent only around 18 % of the total drug expenditures. No statistically significant association was found between total expenditures and the reimbursement rate.

Conclusion: FFS Medicaid drug expenditures decreased from 2010 to 2012 mainly due to a reduction in the total number of prescriptions as also the prices of generic drugs. Thus, higher utilization of generic drugs may offer substantial savings to Medicaid programs at the state level

Keywords: Fee-for-service programs, Medicaid program, Generic drug utilization; Branded drugs, Patient Protection and Affordable Care Act