Missouri HealthNet Pharmacy Program and Budget Update Summary
The Missouri HealthNet Pharmacy Program and Budget Update for July 2023 provides detailed insights into the enrollees, expenditures, and services covered. It highlights the distribution of enrollees among different categories such as children, custodial parents, pregnant women, elderly, and disabled individuals. The document also outlines the expenditures by service, total expenditures over the years from FY20 to FY23, Medicaid expansion details, MAVYRET expenditures, and the top 10 drug classes for FY 2023.
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http://www.nmcfamilyresourcecenter.com/images/dss.gif MO HEALTHNET PHARMACY PROGRAM AND BUDGET UPDATE MISSOURI PHARMACY ADVISORY BOARDS JULY 2023 ELIZABETH SHORT, PROGRAM SPECIALIST
May 2023 Enrollees and Expenditures Other (Children, Custodial Parents, Pregnant Women) 59% Other (Children,Custodial Parents, Pregnant Women) 84% Elderly 3% Disabled 38% Elderly 5% Disabled 11% May 2023 Enrollees Total=1,517,170 July 2022-May 2023 Expenditures Total=$1,730,624,012 2
JULY 2022-MAY 2023 MO HEALTHNET EXPENDITURES BY SERVICE Nursing Facilities 7.89% Hospitals 10.48% Managed Care Premiums 34.07% Dental Services 0.08% Pharmacy 12.87% Part D Copays 0.02% Physician Related 3.35% EPSDT Services 1.00% State Institutions 1.21% In-Home Services 8.10% Mental Health Services 16.72% Rehab & Spec Svcs 1.93% Buy-In Premiums 2.29% 3
FY20-FY23(July 22-May 23) EXPENDITURES $16,000,000,000 $13.4b $14,000,000,000 $12,000,000,000 $11.1b $10.0b $9.4b $10,000,000,000 $8,000,000,000 $6,000,000,000 $4,000,000,000 $1.7b $1.5b $1.4b $1.3b $2,000,000,000 $0 FY20 FY21 FY22 FY23 Total Medicaid Expenditures Total Pharmacy Expenditures 4
MEDICAID EXPANSION May 2023 PARTICIPANTS 351,849 EXPENDITURES $59,627,162 CLAIM COUNT 447,490 5
MAVYRET EXPENDITURES $6,000,000 $5,000,000 $4,000,000 FY19 Total Spend $3,000,000 FY20 Total Spend FY21 Total Spend FY22 Total Spend $2,000,000 FY23 Total Spend $1,000,000 $0 6
TOP 10 DRUG CLASSES FOR FY 2023 FY2023 Expenditures DRUG ADALIMUMAB(Humira) $99,487,265 BIKTARVY(HIV) $66,089,032 TRULICITY(Diabetes) $51,278,722 PALIPERIDONE PALMITATE(Invega) TRIKAFTA(Cystic Fibrosis) $67,088,334 $38,794,870 MAVYRET(Hep C) $39,755,005 INSULIN ASPART(Diabetes) $38,726,312 METHYLPHENIDATE HCL(Stimulant)(Ritalin) CARIPRAZINE HCL(Schizophrenia) BUDESONIDE/FORMOTEROL FUMARATE(Asthma) $40,709,898 $33,386,039 7 $33,502,383
CY2023 PUPM Drug Claim Reimbursement $250 $200 $150 $100 $50 $0 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Children Custodial Parents Elderly Indep Foster Care Child Persons with Disabilities Pregnant Women Expansion 8
FY2020-FY2023 Rare Disease Expenditures Per Day $500,000 $450,000 $400,000 $350,000 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $0 FY2020 Rare Disease Spend FY2021 Rare Disease Spend FY2022 Rare Disease Spend FY2023 Rare Disease Spend 9
