During the October 2018 meeting, the Commission presented results from the first phase of a research project that compared coverage and restrictions for selected drug classes under state Medicaid preferred drug lists and managed care organization formularies to Medicare Part D and commercial payers. The analysis found that Medicaid generally offered broader coverage than other payers but also that Medicaid may place restrictions on more drugs.
This presentation reviews the results from the second phase of this project, which incorporates utilization data to examine the effect of formulary coverage on utilization and whether this effect varies by payer. Additionally, the analysis compares how payers differ in providing coverage for new drugs and how this coverage changes over time and looks at how payers vary in terms of the average gross cost (i.e., before rebates) per 30-day prescription fill within selected drug classes.