Prime Therapeutics presents the 11th edition of the Medicaid Pharmacy Trend Report, offering expert insights into the gross and net spend on traditional and specialty drugs across Medicaid programs. Using the Medicaid Fee-for-Service (FFS) space to the achieve the highest level of accuracy for trend reporting, our annual report shares the classes and drugs with the greatest impact on trend and examines the 12.4% jump in overall net spend trend. We found that branded, traditional drugs – not specialty or generic drugs – drove a 2.5 percentage point decrease in federal rebates this year, the second largest decline in over a decade, and a key factor contributing to higher costs for state Medicaid programs.

Among the report's most notable findings, weight management therapies emerged as the largest driver of pharmacy trend, contributing nearly 15% of the overall increase in net costs and generating more than $100 million in additional net spend across states in the report. The report also explores rising specialty drug costs, evolving manufacturer pricing strategies and opportunities for states to maximize value. Together, these insights provide a timely look at the forces reshaping Medicaid pharmacy spending and what may lie ahead.

The Medicaid Pharmacy Economics section, included in every issue of the report, provides the fundamental background for new readers and those who need a refresher on the calculation of the federal rebate and the impact rebates have on the net price of drugs in the Medicaid program.

Read the report