Analysis of Pharmacy Benefit Managers' Impact on Medicaid Drug Pricing
Release: December 21, 2022
An Analysis of Pharmacy Benefit Managers' Impact on Medicaid Drug Pricing provides some insights into the question of how decision makers can best incorporate Pharmacy Benefit Managers ("PBMs") into the management of Medicaid and CHIP. The report summarizes how PBMs work in practice at the state level to contain retail prescription drug costs in Medicaid programs, and to the extent relevant, how the “Managed Care Organizations (“MCOs”) contract with various state governments to administer Medicaid and CHIP benefits and services. Additionally, the report provides a brief explanation of how the retail prices for prescription drugs are determined at the state level for Medicaid programs in the Managed Care/PBM setting —and how that differs from the traditional Fee-for-Services or FFS setting.
The report also provides a national snapshot of the PBM's impact on drug pricing nationally, and then delves into the impact of PBMs on prescription drug costs in Medicaid and CHIP programs for five states: Illinois, West Virginia, Louisiana, Missouri, and Florida. West Virginia and Missouri are examples of states that use a pharmacy benefit “carve out,” which means some or all Medicaid prescription drug benefits are not included in the state’s respective managed care contracts. Illinois, Florida, and Louisiana were selected as states that rely on a pharmacy benefit “carve in,” which means Medicaid prescription drug benefits are for the most part included in the applicable managed care contracts.
Fully Funding the Evidence-Based Formula: Volume VI
Release: October 1, 2022
Volume VI of the Fully Funding the EBF series continues CTBA’s modeling of fully funding the EBF to 90% of Adequacy, which aligns more closely with the Illinois State Board of Education’s methodology. Volume VI uses the Enacted Fiscal Year 2023 General Fund Budget appropriations for the Evidence-Based Funding formula found in Volume V, but applies the ISBE EBF calculated shortfall for FY 2023 (released in August 2022), rather than a projected shortfall as provided in Volume V. The new release maintains the four scenarios found in the Fully Funding the EBF series Volume V.
Analysis of Illinois' FY 2023 Enacted General Fund Budget
Release: July 1, 2022
Due to Illinois’ long-term, structural fiscal challenges, citizens of Illinois have grown accustomed to General Fund budgets that are focused on cutting, or limiting the cuts to, core services. Which is truly unfortunate, given that 95 percent of all General Fund expenditures on services go to the four core areas of Education, Healthcare, Human Services, and Public Safety. However this past April, the Illinois General assembly passed a General Fund budget for FY 2023 (the “FY 2023 Enacted GF Budget”) that was notably different from the vast majority of budgets passed into law over the last twenty-some odd years. That is because, rather than focus on cuts, the FY 2023 Enacted GF Budget calls for increasing year-to-year spending in every one of those four core service areas. This counters a trend of imposing real, inflation-adjusted cuts to all or most core services that goes all the way back to FY 2000. Moreover, the FY 2023 Enacted GF Budget—when considered in combination with the supplemental appropriations that were passed covering certain aspects of the FY 2022 Enacted General Fund Budget (the “FY 2022 Enacted GF Budget”)—includes a commitment to being fiscally responsible that is far more substantive than rhetorical. This also stands in stark contrast to most General Fund budgets enacted over the last two decades, which on the whole paid lip-service to being responsible—without implementing initiatives that strengthened Illinois’ fiscal system in any meaningful way.
Read the full report to learn more about the initiatives taken to offset economic challenges and decades of service cuts for Illinois.
Fully Funding the Evidence-Based Formula: Volume V
Release: June 20, 2022
Volume V of the Fully Funding the EBF series keeps adjustments to CTBA’s model to align more closely with the Illinois State Board of Education’s methodology and reporting but based on the Enacted Fiscal Year 2023 General Fund Budget appropriations for the Evidence-Based Funding formula. This change is made to the overall Adequacy Gap funding level (changes from 100% to 90% to accommodate for Federal funding). This change in methodology is applied in the same manner as it was for the four scenarios found in the Fully Funding the EBF series Volume V.
Analysis of the Illinois FY 2023 Proposed General Fund Budget
Release: March 29, 2022
The FY 2023 Proposed General Fund Budget (the “FY 2023 GF Proposal”) makes one fact abundantly clear: spending on services is not driving the state’s fiscal problems. Big picture, Illinois’ ongoing disinvestment in General Fund services is harming communities across the state for one simple reason: over 95 percent of all such spending goes to the four, core areas of Education (including Early Childhood, K-12, and Higher Education), Healthcare, Human Services, and Public Safety. The FY 2023 GF Budget Proposal is a change of pace, reversing the trend of disinvesting in General Fund services by increasing spending for every single General Fund service category and making moves to get Illinois’ fiscal house in order.