Utilization and Spending Trends in Medicaid Outpatient Prescription Drugs, 2014-2017

Appendix A: Tables

Table A1: Top 10 Drug Groups by Prescriptions
Rank	2014	2015	2016	2017
1	Analgesics – Opioid (40,443,041)	Antidepressants (44,868,553)	Antidepressants (49,299,537)	Antidepressants (52,208,872)
2	Antiasthmatic and Bronchodilator Agents (40,076,215)	Antiasthmatic and Bronchodilator Agents (43,465,120)	Antiasthmatic and Bronchodilator Agents (46,392,776)	Antiasthmatic and Bronchodilator Agents (47,221,760)
3	Antidepressants (38,134,482)	Analgesics – Opioid (42,878,656)	Analgesics – Opioid (42,797,301)	Anticonvulsants (38,473,276)
4	Anticonvulsants (29,111,977)	Anticonvulsants (33,644,651)	Anticonvulsants (36,913,446)	Analgesics – Opioid (38,445,789)
5	Antihypertensives (26,825,330)	Antihypertensives (31,427,118)	Antihypertensives (34,158,826)	Antihypertensives (34,870,056)
6	Dermatologicals (24,751,860)	Analgesics – Anti-Inflammatory (28,900,169)	Analgesics – Anti-Inflammatory (31,058,834)	Analgesics – Anti-Inflammatory (31,546,029)
7	Analgesics – Anti-Inflammatory (24,618,998)	Dermatologicals (26,805,736)	Antidiabetics (29,694,134)	Antidiabetics (30,972,939)
8	Antihistamines (23,315,441)	Antidiabetics (26,338,009)	Ulcer Drugs (28,268,099)	Ulcer Drugs (28,551,449)
9	Ulcer Drugs (23,035,113)	Ulcer Drugs (26,314,817)	Antihistamines (28,089,627)	Antihistamines (28,509,398)
10	Antidiabetics (21,860,462)	Antihistamines (25,973,412)	Dermatologicals (27,921,469)	Dermatologicals (28,089,695)
Source: Kaiser Family Foundation analysis of Medicaid State Drug Utilization Data, 2014-2017; Wolters Kluwer Clinical Drug Information, Inc., January 2018.

Table A2: Top 10 Drug Groups by Medicaid Paid Amount
Rank	2014	2015	2016	2017
1	Antivirals ($5,634,419,735)	Antivirals ($7,604,610,681)	Antivirals ($8,986,987,908)	Antivirals ($8,645,443,492)
2	Antipsychotics/ Antimanic Agents ($5,219,140,280)	Antipsychotics/ Antimanic Agents ($5,954,459,891)	Antidiabetics ($5,612,449,234)	Antidiabetics ($6,163,521,823)
3	Antiasthmatic & Bronchodilator Agents ($3,946,968,379)	Antidiabetics ($4,543,030,175)	Antipsychotics/ Antimanic Agents ($5,291,224,179)	Antiasthmatic & Bronchodilator Agents ($5,246,389,751)
4	ADHD/Anti-Narcolepsy/ Anti-Obesity/ Anorexiants ($3,325,666,946)	Antiasthmatic & Bronchodilator Agents ($4,509,339,296)	Antiasthmatic & Bronchodilator Agents ($5,081,859,758)	Antipsychotics/ Antimanic Agents ($4,675,185,444)
5	Antidiabetics ($3,224,765,165)	ADHD/Anti-Narcolepsy/ Anti-Obesity/ Anorexiants ($3,668,785,052)	ADHD/Anti-Narcolepsy/ Anti-Obesity/ Anorexiants ($3,702,032,122)	ADHD/Anti-Narcolepsy/ Anti-Obesity/ Anorexiants ($3,629,296,232)
6	Anticonvulsants ($1,973,858,661)	Anticonvulsants ($2,481,702,094)	Anticonvulsants ($2,833,182,272)	Antineoplastics & Adjunctive Therapies ($3,200,282,451)
7	Antineoplastics & Adjunctive Therapies ($1,777,171,748)	Antineoplastics & Adjunctive Therapies ($2,268,353,599)	Antineoplastics & Adjunctive Therapies ($2,784,098,702)	Anticonvulsants ($3,068,292,420)
8	Analgesics – Opioid ($1,699,532,425)	Analgesics – Opioid ($1,951,254,619)	Analgesics – Anti-Inflammatory ($2,519,896,812)	Analgesics – Anti-Inflammatory ($2,989,000,836)
9	Dermatologicals ($1,412,206,537)	Dermatologicals ($1,886,913,962)	Dermatologicals ($2,071,058,258)	Dermatologicals ($2,007,038,332)
10	Hematological Agents – Misc. ($1,346,289,358)	Analgesics – Anti-Inflammatory ($1,769,811,192)	Analgesics – Opioid ($1,997,426,544)	Hematological Agents – Misc. ($1,876,126,156)
Note: Medicaid spending does not include rebates. Source: Kaiser Family Foundation analysis of Medicaid State Drug Utilization Data, 2014-2017; Wolters Kluwer Clinical Drug Information, Inc., January 2018.

Appendix B: Methodology

This analysis of Medicaid prescription drug utilization and spending trends, we used 2014 through 2017 State Drug Utilization Data (SDUD), downloaded in early January 2019, merged with data from Wolters Kluwer Clinical Information, Inc (“WKCDI”).¹ The SDUD is publicly available data provided as part of the Medicaid Drug Rebate Program. It provides data on the number of prescriptions, Medicaid spending before rebates, and cost-sharing for rebate-eligible Medicaid outpatient drugs. At the time of download, 2017 data were the most recent full year of data available. The WKCDI data is from January 2018. The use of WKCDI data does not represent and should not be characterized as a WKCDI endorsement of any data, findings, or other content presented in this report.

The SDUD and the WKCDI data were merged at the NDC-level to consistently identify the drug name, as well as to incorporate brand versus generic status and the WKCDI Therapeutic Classifications System’s drug group. Single-source and multi-source, originator drugs were classified as brand drugs. If a drug was available as both a brand and a generic, it was categorized as a brand when summarizing how many of the most costly drugs were brands and how many were generics. Using the Center for Drug Evaluation and Research List of Licensed Biological Products and the Center for Biologics Evaluation and Research List of Licensed Biological Products² as of March 2018, biologics in the SDUD were identified based on drug name.

Limitations

The SDUD provides spending and utilization data by NDC, quarter, managed care or fee-for-service, and state. It also provides this data summarized for the whole country. Starting in 2016, CMS has suppressed data cells with fewer than 11 prescriptions, citing the Federal Privacy Act and the HIPAA Privacy Rule.³ Because less data is suppressed at the national versus state level, this analysis used the national data. Comparing 2015 data available prior to the methodology change to 2015 data after the methodology change, this data suppression at the national level does not dramatically alter findings at the macro level as shown in this brief. It does alter analyses examining the most costly drug per prescription, but this type of analysis is beyond the scope of this brief.

This analysis does not include rebates because this data is unavailable to the public at the NDC level. Rebates have a considerable effect on Medicaid drug spending overall, lowering net spending, but this effect varies at the drug level as different drugs receive different rebates. Additionally, although Medicaid beneficiaries largely self-administer drugs that are prescribed in an outpatient setting, medical practitioners must administer some drugs. Although states are instructed to collect drug rebates on physician-administered outpatient drugs that are not billed as a bundled service, research has shown that not all states do so.⁴ Because biologics and other specialty drugs are often physician-administered, it is possible that the data reflects lower Medicaid spending and utilization of certain drugs of this kind.