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State strategies to address medicaid prescription spending: negotiated pricing vs price transparency

Published online by Cambridge University Press:  30 April 2020

Shihyun Noh Open the ORCID record for Shihyun Noh [Opens in a new window] ,
Christian L. Janousek  and
Ji Hyung Park
Shihyun Noh*
Affiliation:
Department of Public Administration, State University of New York College at Brockport, Rochester, New York, USA
Christian L. Janousek
Affiliation:
University of Nebraska at Omaha, Nebraska, USA
Ji Hyung Park
Affiliation:
Department of Political Science, James Madison University, Harrisonburg, Virginia, USA
*
*Corresponding author. Email: [email protected]
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Abstract

This research longitudinally examines the association between levels of state Medicaid prescription spending and the state strategies intended to constrain cost increases: the negotiated pricing strategy, as indicated by state rebate programs, and the price transparency strategy, as indicated by state operation of All-Payer Claims Databases. The findings demonstrate evidence that state Medicaid prescription spending is influenced by the negotiated pricing strategy, especially Managed Care Organization (MCO) rebates under the Patient Protection and Affordable Care Act, but not influenced by the price transparency strategy. State decisions for MCO rebates, such as carving prescription benefits into managed care benefits, were effective in containing levels of Medicaid prescription spending over time, while other single- and multi-state rebate programs were not. Based on these findings, state policymakers may consider utilizing the MCO rebate program to address increases in Medicaid prescription spending.

Keywords

Affordable Care ActAll payer claims databasesMedicaid prescription spendingNegotiated pricingPrice transparency
Type
Article
Information
Health Economics, Policy and Law , Volume 16 , Issue 2 , April 2021 , pp. 201 - 215
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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References

APCD Council (2015) New York's all payer database: a new lens for consumer transparency. Available at http://nyshealthfoundation.org/uploads/resources/new-york-all-payer-database-a-new-lens-for-consumer-transparency-sept-2015.pdf.Google Scholar
APCD Council (2017 a) Interactive state report map. Available at http://www.apcdcouncil.org/state/map.Google Scholar
APCD Council (2017 b) Releasing APCD data: how states balance privacy and utility. Available at https://www.apcdcouncil.org/publication/releasing-apcd-data-how-states-balance-privacy-and-utility.Google Scholar
Arellano, M and Bond, S (1991) Some tests of specification for panel data: Monte Carlo evidence and an application to employment equations. The Review of Economic Studies 58, 277–297.CrossRefGoogle Scholar
Barrilleaux, C (1999) Governors, bureaus, and state policymaking. State and Local Government Review 31, 53–59.CrossRefGoogle Scholar
Bernick, EL (2016) Studying governors over five decades: what we know and where we need to go? State and Local Government Review 48, 132–146.CrossRefGoogle Scholar
Berry, WD, Ringquist, EJ, Fording, RC and Hanson, RL (2015) Assessing the validity of Enns and Koch's measure of state policy mood. State Politics & Policy Quarterly 15, 425–435.CrossRefGoogle Scholar
Blais, A, Blake, D and Dion, S (1993) Do parties make a difference? Parties and the size of government in liberal democracies. American Journal of Political Science 37, 40–62.CrossRefGoogle Scholar
Blavin, F, Karpman, M, Kenney, G and Sommers, B (2018) Medicaid versus marketplace coverage for near-poor adults: effects on out-of-pocket spending and coverage. Health Affairs 37, 299–307.CrossRefGoogle ScholarPubMed
Blumenthal, D and Squires, D (2016) Drug price control: how some government programs do it. Available at http://www.commonwealthfund.org/publications/blog/2016/may/drug-price-control-how-some-government-programs-do-it.Google Scholar
Boushey, GT and McGrath, RJ (2017) Experts, amateurs, and bureaucratic influence in the American states. Journal of Public Administration Research and Theory 27, 85–103.CrossRefGoogle Scholar
Cantor, JC, Thompson, FJ and Farnham, J (2013) States’ commitment to medicaid before the affordable care act: trends and implications. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 50, 71–84.CrossRefGoogle ScholarPubMed
Centers for Medicare and Medicaid Services (2018) Quick definitions for National Health Expenditure Accounts (NHEA) Categories. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/quickref.pdf.Google Scholar
Desai, S, Hatfield, LA, Hicks, AL, Chernew, ME and Mehrotra, A (2016) Association between availability of a price transparency tool and outpatient spending. JAMA 315, 1874–1881.CrossRefGoogle Scholar
Elazar, DJ (1967) “Fragmentation” and local organizational response to Federal-city programs. Urban Affairs Review 2, 30–46.CrossRefGoogle Scholar
Feldstein, PJ (2015) Health Policy Issues: An Economic Perspective, 6th Edn. Chicago, IL: Health Administration Press.Google Scholar
Goggin, M, Bowman, A, Lester, J and O'Toole, LJ (1990) Implementation Theory and Practice: Toward a Third Generation. Glenview, Illinois, USA: Foresman and Company.Google Scholar
Hibbard, JH, Greene, J, Sofaer, S, Firminger, K and Hirsh, J (2012) An experiment shows that a well-designed report on costs and quality can help consumers choose high-value health care. Health Affairs 31, 560–568.CrossRefGoogle ScholarPubMed
Hill, LB (1991) Who governs the American administrative state? A bureaucratic-centered image of governance. Journal of Public Administration Research and Theory 1, 261–294.Google Scholar
Hsu, J, Fung, V, Price, M, Huang, J, Brand, R, Hui, R, Fireman, B and Newhouse, JP (2008) Medicare beneficiaries’ knowledge of part D prescription drug program benefits and responses to drug costs. JAMA 299, 1929–1936.CrossRefGoogle Scholar
Jacobs, LR and Callaghan, T (2013) Why states expand medicaid: party, resources, and history. Journal of Health Politics, Policy and Law 38, 1023–1050.CrossRefGoogle ScholarPubMed
Jordan, S and Bowling, CJ (2016) The state of polarization in the states. State and Local Government Review 48, 220–226.CrossRefGoogle Scholar
Kaiser Family Foundation (KFF) (2015) Paying for prescribed drugs in Medicaid: current policy and upcoming changes. Available at https://kaiserfamilyfoundation.files.wordpress.com/2014/05/8593-paying-for-prescribed-drugs-in-medicaid-current-policy-and-upcoming-changes.pdf.Google Scholar
Kaiser Family Foundation (KFF) (2017) Total medicaid managed care enrollment. Available at https://www.kff.org/medicaid/state-indicator/total-medicaid-mc-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.Google Scholar
Kaiser Family Foundation (KFF) (2018 a) Snapshots of recent state initiatives in Medicaid prescription drug cost control. Retrieved from http://files.kff.org/attachment/Issue-Brief-Snapshots-of-Recent-State-Initiatives-in-Medicaid-Prescription-Drug-Cost-Control.Google Scholar
Kaiser Family Foundation (KFF) (2018 b) The effects of Medicaid expansion under the ACA: updated findings from a literature review. Retrieved from http://files.kff.org/attachment/Issue-Brief-The-Effects-of-Medicaid-Expansion-Under-the-ACA-Updated-Findings-from-a-Literature-Review.Google Scholar
Lindblom, CE (1959) The science of “muddling through”. Public Administration Review 19, 79–88.CrossRefGoogle Scholar
Martin, AB, Hartman, M, Benson, J and Catlin, A and National Health Expenditure Accounts Team (2015) National health spending in 2014: faster growth driven by coverage expansion and prescription drug spending. Health Affairs 35, 150–160.CrossRefGoogle ScholarPubMed
Medicaid and CHIP Payment and Access Commission (MACPAC) (2011) The evolution of managed care in Medicaid. Available at https://www.macpac.gov/wp-content/uploads/2015/01/MACPAC_June2011_web.pdf.Google Scholar
Medicaid and CHIP Payment and Access Commission (MACPAC) (2016) Medicaid spending for prescription drugs. Available at https://www.macpac.gov/wp-content/uploads/2016/01/Medicaid-Spending-for-Prescription-Drugs.pdf.Google Scholar
Medicaid.gov (2017 a) State prescription drug resources. Available at https://www.medicaid.gov/medicaid/prescription-drugs/state-prescription-drug-resources/index.html.Google Scholar
Medicaid.gov (2017 b) Medicaid pharmacy Supplemental Rebate Agreements (SRA). 2017. Available at https://www.medicaid.gov/medicaid-chip-program-information/by-topics/prescription-drugs/downloads/xxxsupplemental-rebates-chart-current-qtr.pdf (Accessed 28 August 2017).Google Scholar
Miller, EA (2005) State health policy making determinants, theory, and methods: a synthesis. Social Science & Medicine 61, 2639–2657.CrossRefGoogle Scholar
National Conference of State Legislatures (2011) Health cost containment and efficiencies. Available at http://www.ncsl.org/documents/health/introandbriefscc-16.pdf.Google Scholar
National Conference of State Legislatures (2018) State legislative policymaking in an age of political polarization. Available at http://www.ncsl.org/.Google Scholar
Nicholson-Crotty, S (2015) Governors, Grants, and Elections: Fiscal Federalism in the American States. Baltimore: Johns Hopkins University Press.Google Scholar
Noh, S (2016) Federal strategies to induce resistant states to participate in the ACA health exchanges. State and Local Government Review 48, 227–235.CrossRefGoogle Scholar
Noh, S and Krane, D (2016) Implementing the affordable care act health insurance exchanges: state government choices and policy outcomes. Publius: The Journal of Federalism 46, 416–440.CrossRefGoogle Scholar
Pressman, JL and Wildavsky, AB (1984) Implementation: How Great Expectations in Washington Are Dashed in Oakland, or, Why It's Amazing That Federal Programs Work at all, This Being a Saga of the Economic Development Administration as Told by Two Sympathetic Observers Who Seek to Build Morals on a Foundation of Ruined Hopes. Berkeley, CA: University of California Press.Google Scholar
Rosenthal, JA, Lu, X and Cram, P (2013) Availability of consumer prices from US hospitals for a common surgical procedure. JAMA Internal Medicine 173, 427–432.CrossRefGoogle ScholarPubMed
Selden, TM, Lipton, BJ and Decker, SL (2017) Medicaid expansion and Marketplace eligibility both increased coverage, with trade-offs in access, affordability. Health Affairs 36, 2069–2077.CrossRefGoogle ScholarPubMed
Sinaiko, AD and Rosenthal, MB (2011) Increased price transparency in health care – challenges and potential effects. New England Journal of Medicine 364, 891–894.CrossRefGoogle ScholarPubMed
Soni, A, Simon, K, Cawley, J and Sabik, L (2018) Effect of Medicaid expansions of 2014 on overall and early-stage cancer diagnoses. American Journal of Public Health 108, 216–218.CrossRefGoogle ScholarPubMed
Sparer, MS and Thompson, FJ (2015) Government and health insurance: the policy process. In Knickman, JR and Kovner, AR (eds), Health Care Delivery in the United States, 11th Edn. New York: Springer Publishing Company, pp. 29–52.Google Scholar
Stock, JH, Wright, JH and Yogo, M (2002) A survey of weak instruments and weak identification in generalized method of moments. Journal of Business & Economic Statistics 20, 518–529.CrossRefGoogle Scholar
Weissert, CS and Uttermark, MJ (2017) Glass half full: decentralization in health policy. State and Local Government Review 49, 199–214.CrossRefGoogle Scholar
Wildavsky, A (1984) Politics of the Budgetary Process. Boston: Little Brown.Google Scholar
Winkelman, TN and Chang, VW (2018) Medicaid expansion, mental health, and access to care among childless adults with and without chronic conditions. Journal of General Internal Medicine 33, 376–338.CrossRefGoogle ScholarPubMed
Wooldridge, JM (2010) Econometric Analysis of Cross Section and Panel Data. Cambridge: MIT Press.Google Scholar