What do states pay?  Explore the CMS State Utilization Database

Once a quarter, the Centers for Medicare and Medicaid Services (CMS) publishes detailed Medicaid spending data down to the National Drug Code (NDC) level through what’s known as the State Utilization Database.  On its own, it’s somewhat challenging to use due to poor drug naming conventions and the lack of any reference pricing.  However, when merged with CMS's National Average Drug Acquisition Cost (NADAC) database, it comes to life! With this viz (a.k.a visualization), you can see the average invoice prices pharmacies pay for every medication, and then compare it to what the state is being charged.  Have fun exploring the madness that is Medicaid drug pricing.

Data Sources

How we Created our Dataset

  1. 46brooklyn's visualization tool of choice = Tableu Prep

  2. Lag effect NADAC prices (NADAC is reported on roughly a one-month lag)

  3. Aggregate weekly NADAC into quarterly NADAC

  4. Join State Utilization Database and lagged quarterly NADAC on NDC and Year-Quarter

How to Use   

  1. Choose brand or generic (generics are where PBMs are the “price-setters”)

  2. Choose a drug name from the list, or start typing one in

  3. Choose the program type – Managed Care or Fee for Service

  4. Select the time period (Year / Quarter)

  5. Select the “metric” - either State Payment per Unit or Markup per Unit

  6. Set the Minimum Total Spend - this allows you to automatically adjust the color scale using only meaningful data

  7. Hover over any state to see the time series of what was paid versus its NADAC (depending on your Internet connection, it may take a second or two for the charts to load)

NOTE: Drug list filtered to pills and tablets to avoid potential unit mismatches between databases.  Q1 2018 state utilization data (to us) appears to be incomplete at this time.  We will update this dashboard again when CMS re-publishes its 2018 dataset.  This viz is easiest to use on a desktop, as you can enter text in the dropdown filters to speed up your search.  Unfortunately there is no text entry option on tablets and mobile devices, so you have to scroll through the list.  Apologies for the inconvenience!  We'll update as soon as we figure out a hack to enable text entry.

Have questions on this viz?  Check out the FAQ page.  Don't see your question on the page?  Contact us!

v 2.4 - posted August 20, 2019
For full release notes click here