What do states pay? Explore 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 know 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, you can see the average 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.
The Story of this Viz...
The concept for this viz came from wanting simply to understand how drug prices varied from state to state. Call us crazy, but we didn't understand anecdotes we were hearing where two neighboring states paid vastly different amouts for the same drug at the same time. Turns out that's exactly what's happening! Especially for generic drugs. And worse off, some states are paying multiples of what the drug actually costs.
Managed Care Orginizations (MCOs), tasked by state Medicaid departments to manage Medicaid spending, often subcontract prescription management to a Pharmacy Benefit Manager (PBMs). We aren't privy to the details of these contracts between MCOs and PBMs, but the data is speaking volumes on what these contracts must look like. CMS data strongly suggests that many PBMs have significant flexibility to charge the state some other "cost" that is wildly different from the actual cost. 🤔 Let the confusion ensue!
How to Use
- Choose brand or generic (generics are where PBMs have more leeway to set their own prices)
- Choose a drug name from the list, or start typing one in
- Choose the program type - Managed Care or Fee for Service
- Select the time period
- Hover over any state to see the time series of what was paid versus its NADAC