2018 Payer Digest SAUS.105.18.08.5100

2 PAY E R D I G E S T TM 2 0 1 8 SANOFI / MANAGED CARE DIGEST SERIES ® / WHERE INFORMATION BECOMES INTELLIGENCE . ™ C O N T E N T S , V O L . 3 2 ( C O N T . ) CONTENTS Financials Medicare Fee-for-Service Total Costs Continue to Rise............................................................................................ 36 Growth Slows for Medicare’s Managed Care Spending Share............................................................................... 37 Medicare Reimbursement for IP Cases Rises in 2016................................................................................................. 38 Share of Hospitals Penalized for Excess Readmissions Declines............................................................................... 39 Pharmacy Coverage Gap Affects Large Shares of Patients with Chronic Dxs......................................................................... 40 California Leads the Nation in Medicare PDP Enrollment......................................................................................... 41 Pharmacy Share of Medicare HMO Operating Expenses Rises............................................................................... 42 Generics Account for at Least 90% of Many Medicare Rxs .................................................................................... 43 Medicare Part D Rx Counts Rise for Most Disease Indications.................................................................................. 44 MEDICAID Backgrounder.............................................................................................................................................................. 45 Demographics Medicaid MCO Enrollment Growth Slows to 1% in 2017........................................................................................... 46 Medicaid Covers Majority of Diagnoses Involving Injury, External Causes............................................................. 47 Half of Managed Care Plans in Michigan Are Comprehensive MCOs................................................................... 48 Utilization Low Percentages of Diabetes Patients Have A1c Tests in the Carolinas ............................................................... 49 Utilization Rates Rise for Medicaid HMO Members.................................................................................................... 50 Financials Spending Per Capita Nears $6,700 for Medicaid MCOs in New York..................................................................... 51 Medicaid MCO Spending Share Exceeds 80% in Three States................................................................................ 52 Managed Medicaid ED Professional Charges Rise in 2017...................................................................................... 53 Pharmacy Medicaid Rx Payer Shares Climb for 12 Disease Indications.................................................................................... 54 OOP Costs Decrease for Medicaid Managed Care Rxs.......................................................................................... 55 Medicaid Payer Share of Asthma Rxs Exceeds Other Indications........................................................................... 56 Rx Numbers Rise for Managed Medicaid Common Products................................................................................. 57 LOOKING FORWARD..................................................................................................................58 RESEARCH METHODOLOGY.......................................................................................................60 KEY TERMS...................................................................................................................................62 REFERENCES................................................................................................................................64 Comparative information at regional, state, and local levels is available by contacting your Sanofi account executive.

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