Each state designs their own Medicaid program within broad federal guidelines and can decide whether to provide prescription drug coverage, an optional benefit under the Medicaid program. All states currently provide prescription drug coverage with some states administering pharmacy benefits directly and other states using Medicaid managed care plans to oversee pharmacy benefits to beneficiaries. Unfortunately, some states are attempting to limit access to brand medicines in Medicaid by implementing policies that control which medicines patients can get or restricting how many prescriptions patients can fill each month. Policies that limit access to medicines in Medicaid could put millions of people at risk, lead to poorer health outcomes for already vulnerable populations, and contribute to higher costs across the health care system.
Across the country, Medicaid spending on prescription medicines remains low. In 2020, Medicaid programs spent on average just 4.5% of their budgets on retail prescription medicines, a number that has remained consistent over time and is projected to remain a small share. At the same time, biopharmaceutical manufacturers paid more than $39 billion in 2020 in mandatory and negotiated supplemental rebates to the Medicaid program, shared between states and the federal government.
Medicaid in your State
Click your state below to learn more about Medicaid spending data and the value that drugs bring to the Medicaid program and patients.
PhRMA submitted the following comments on Tennessee's plan to amend Section 1115, a plan which requests new flexibilities and certain exemptions for TennCare administrators from federal oversight. PhRMA has grave concerns about the impact the drug-related proposals would have on Medicaid beneficiaries' access to crucial medications, and urges CMS not to approve these elements of Tennessee's proposal.