Medicaid Program Expenditure Analysis August 2022

Analysis of Medicaid program expenditures in August 2022 reveals interesting insights. Total enrollees in August 2022 were 1,358,275 with total expenditures amounting to $304,664,691.2. The report delves into expenditure distribution across various services, top drug classes per fiscal year, and Medicaid expansion figures for August 2022. Noteworthy data includes the breakdown of enrollees by category, pharmacy program updates, and budgetary updates. The analysis provides a comprehensive overview of Medicaid spending trends over the specified period.

• Medicaid
• Expenditure Analysis
• Enrollees
• Pharmacy Program
• Budget Update

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1. http://www.nmcfamilyresourcecenter.com/images/dss.gif MO HEALTHNET PHARMACY PROGRAM AND BUDGET UPDATE MHD DRUG UTILIZATION REVIEW BOARD OCTOBER 19, 2022 ELIZABETH SHORT, PROGRAM SPECIALIST

2. August 2022 Enrollees and Expenditures Other (Children, Custodial Parents, Pregnant Women) 54% Other (Children,Custodial Parents, Pregnant Women) 82% Elderly 3% Disabled 43% Elderly 6% Disabled 12% Aug 2022 Enrollees Total=1,358,275 Aug 2022 Expenditures Total=$304,664,691 2

3. JULY-AUG 2022 MO HEALTHNET EXPENDITURES BY SERVICE Nursing Facilities 8.70% Managed Care Premiums 30.18% Hospitals 10.27% Dental Services 0.05% Pharmacy 13.82% EPSDT Services 0.98% Part D Copays 0.02% Physician Related 3.66% State Institutions 1.42% In-Home Services 8.98% Mental Health Services 17.13% Buy-In Premiums 2.59% Rehab & Spec Svcs 2.18% 3

4. FY20-FY23 EXPENDITURES $12,000,000,000 $11.1b $10.0b $10,000,000,000 $9.4b $8,000,000,000 $6,000,000,000 $4,000,000,000 $2.2m $2,000,000,000 $1.5b $1.4b $1.3b $304.6m $0 FY20 FY21 FY22 FYTD23 Total Medicaid Expenditures Total Pharmacy Expenditures 4

5. MEDICAID EXPANSION AUGUST 2022 PARTICIPANTS 240,649 EXPENDITURES $27,748,551 CLAIM COUNT 236,485 5

6. TOP 4 DRUG CLASSES PER FY FY2021 Expenditures FY2021 Claim Count Paliperidone Palmitate(Invega) $50,783,647 19,191 Adalimumab(Humira) $47,631,914 6,928 Lurasidone HCL(Latuda) $40,962,690 34,399 Methylphenidate HCL(ADHD) $32,590,476 121,636 FY2022 Expenditures FY2022 Claim Count Adalimumab(Humira) $65,085,308 8,983 Paliperidone Palmitate(Invega) $55,188,350 20,453 Lurasidone HCL(Latuda) $43,154,241 35,334 Methylphenidate HCL(ADHD) $35,358,173 130,708 FYTD2023 Expenditures FYTD2023 Claim Count Adalimumab(Humira) $29,579,181 3,807 Paliperidone Palmitate(Invega) $20,676,480 7,453 Biktarvy(HIV) $17,384,640 5,528 Lurasidone HCL(Latuda) $15,640,214 12,628 6

7. PHARMACY EXPENDITURES JULY -OCT 2022 $200,000,000 $175,617,923 35 day cycle $180,000,000 $156,682,201 28 day cycle $154,658,432 31 day cycle $160,000,000 $139,439,553 28 day cycle $140,000,000 $120,000,000 $100,000,000 $80,000,000 $60,000,000 $40,000,000 $20,000,000 $0 7

8. PHARMACY SPECIALTY AND NON-SPECIALTY JULY-OCT 2022 $120,000,000 $110,681,212 $100,000,000 $99,677,360 $99,728,058 $86,807,860 $80,000,000 $64,936,712 $60,000,000 $57,004,841 $54,930,374 $52,631,693 $40,000,000 $20,000,000 $0 Non-Specialty Paid Amount Specialty Paid Amount 8

9. MAVYRET EXPENDITURES $4,000,000 $3,500,000 $3,000,000 $2,500,000 FY19 Total Spend $2,000,000 FY20 Total Spend FY21 Total Spend $1,500,000 FY22 Total Spend FY23 Total Spend $1,000,000 $500,000 $0 Dec Nov Jan Mar Feb July June Apr May Oct Sept Aug 9

10. Sept 2022 TOP TEN REIMBURSED DRUGS FOR CHILDREN 0-17 10

11. CY2022 PUPM Drug Claim Reimbursement $250 $200 Children $150 Custodial Parents Elderly Indep Foster Care Child Persons with Disabilities Pregnant Women $100 Expansion $50 $0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec 11

12. FY2020-FYTD 2023 Rare Disease Expenditures Per Day $500,000 $400,000 $300,000 $200,000 $100,000 $0 July Aug Sept Oct Nov Dec Jan Feb Mar AprilMay June FY2020 Rare Disease Spend FY2021 Rare Disease Spend FY2022 Rare Disease Spend FYTD2023 Rare Disease Spend 12