Managed Care Medicaid’s Top 20 over $20 List

Here’s yet another way to help find “markup” (payer cost less NADAC cost) within managed care Medicaid. Our Top 20 over $20 list provides you with an interactive way to view the 20 top drugs (ranked by absolute markup dollars) that sported a markup per prescription of $20 or more for any state that has managed care, and time period (going back to 2014). Why $20 per prescription? Because that is a ballpark number that we believe is excessive for the supply chain to take on a typical generic claim.  As we have written about extensively, most pharmacy dispensing fee surveys result in break-even professional dispensing fees of around $10-11 per prescription.  So once we get to $20, we feel comfortable claiming that this is pushing the bounds of what’s reasonable.

For more detail on how this visualization came to be - and several examples on how it can be used in conjunction with our other visualizations - please read through our Q2 State Utilization research report

Data Sources

How we Created our Dataset

  1. 46brooklyn's visualization tool of choice = Tableau 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. Select one or more states

  2. Select one or more time periods

  3. Flip over to our Medicaid Drug Pricing Heat Map to view trend charts of any of the top 20 over $20 drugs for any state

    NOTE: If you are attempting to view all states for Q2 2018, make sure that you do NOT include New York. New York’s Q2 data was reported incorrectly, and must be removed from country-wide aggregation to arrive at fair numbers. To read more on this, click here.

v 1.3 - posted August 20,2019
For full release notes click here