Medicaid Prescription Drug Management: Quality Scores Compared Across Different Approaches

November 2023

States that employ managed care organizations (MCOs) to manage the Medicaid prescription drug benefit collectively exhibit higher scores on pharmacy-related clinical quality measures than states that rely on the fee-for-service (FFS) program to administer the benefit.

States have increasingly implemented capitation contracting with managed care organizations (MCOs) in seeking greater access, cost containment, and quality outcomes and accountability in their Medicaid programs. Prior research has confirmed that states can achieve the greatest savings through MCOs’ management of the drug benefit when compared to a FFS model.

This analysis highlights the clinical value that MCOs can also deliver when administering the prescription drug benefit in state Medicaid programs as part of their integrated system of care coordination. Large-scale comparisons of HEDIS quality scores were made between the MCO and FFS settings, with each of these considering a broad set of relevant measures and reporting years. In 97 percent of these instances, the fully MCO-managed model outperformed the FFS model.

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Topics

Medicaid Prescription Drug Benefit
Quality Scores Among Medicaid Pharmacy Benefit Models
Methods
Policy Considerations

Full report

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