Specialty drug spending is becoming a growing share of Medicaid pharmacy budgets. MACPAC’s analysis of data for 2014 to 2017 show that high-cost drugs (those over $1,000 per claim) are an increasing portion of claims and gross spending.
This presentation outlines the Commission’s current and upcoming work on high-cost specialty drugs. In October, MACPAC convened a technical advisory panel to discuss the specialty drug pipeline and the challenges these drugs present to Medicaid. The panel will reconvene in November and December to develop payment and coverage models, specifying their design parameters, and considering the potential effect on various stakeholders.
For the second part of this presentation, Caroline Pearson, senior vice president at NORC, shares work done under contract with MACPAC to inform the discussion at the first technical advisory panel meeting. Her analysis identifies pipeline drugs that could have a disproportionate or significant effect on Medicaid and describes their characteristics and the challenges they may present to Medicaid.