Under Pressure: Prescription Drug Spending Trends in New York's Medicaid Program and Small Group Market

This issue brief analyzes recent growth in spending for prescription drugs by health plans in New York State-and the implications of that growth for policymakers and consumers. Prescription drug cost increases are exerting considerable pressure on the state budget, public and private health plans, and enrollees, and will likely continue to do so.

The brief presents per member per month (PMPM) data over time for health plans in two markets: Medicaid Managed Care and small group commercial. Among commercial plans, PMPM drug spending rose an average of 62 percent between 2011 and 2016. Among Medicaid Managed Care plans, which report spending for certain higher cost drugs in a separate category, PMPM drug spending rose an average of 21 percent between 2013 and 2015.

Restraining the rate of growth in these costs will involve a difficult balancing act, and strong collaboration among all parties-particularly amid federal calls for significant cuts in state Medicaid funding, and reductions in premium and cost-sharing subsidies.

Read the related press release.