McHenry Times

Rep. Steven Reick (R-Woodstock) wanted a breakdown of real-time pharmacy data at a recent House Appropriations-Human Services Committee hearing.

Reick posed more than one question to Milliman Principal Consulting Actuary Robert Damler on pharmacy figures at the Dec. 18 hearing on a $60 billion Managed Care organizations (MCOs) and commercial insurance revamp plan to increase managed care to Medicaid patients.

“My understanding of the actuarial arts is that you take real-time data and apply your own wizardry, or whatever you want to call it, and then you give us information that we can act upon,” Reick said when questioning how Damler actually obtains objective data from the particular plans he is approached with.

Reick cited statistics that revealed the percentage of Illinois Medicaid pharmacy expenditures for prescriptions costing over $1,000 rose from 28.2 percent in the first quarter of 2013 to 43.4 percent in the second quarter of 2017.

“That has to be a huge cost driver to the increases you are looking at?” Reick asked. 

The answer was apparent, according to Damler.

“Between 2013 and 2017 there has been a fairly significant shift in population coverage,” Damler said, noting the shift is based on the age and gender of patients, with the adult population costing much more since the Obama administration ruling on Medicaid. “Most of your drug spending prior to the Affordable Care Act was on the family and children population, and so it is a different mix you are seeing for the numbers enrolled.”

Reick also wanted to know the federal government’s role in the cost of Illinois Medicaid coverage.

“How much do federal reimbursement rates provide a disincentive for state plans to cut cost?” Reick asked, adding he read an article earlier in the day that the average federal matching rate is now 62 to 64 percent of Medicaid costs depending on the year.

“We get 50 percent, but still doesn’t that federal reimbursement provide a disincentive for cutting costs because there is so much money supposedly coming from the federal government?” Reick asked.

Samantha Olds Frey, executive director at the Illinois Association of Medicaid Health Plans, answered Reick.

“I think Illinois has done quite a bit of painful work to decrease expenditures to the best of their ability and we actually as a state have one of the lowest per capita spending in the Medicaid program nationally,” Old Freys said, adding depending on the year, the state fluctuates between 48 and 51 percent, which is much better than other states.

“I can say with certainty Illinois is not one of the states that doesn’t look at truly managing the Medicaid program,” Old Freys added.