Washington State's Health Care Authority, which coordinates the Prescription Drug Program for the state's Medicaid, public employee, and worker compensation programs, is using an integrated approach to value-based pharmaceutical purchasing. The evidence-based drug review process involves a thorough analysis of quality and effectiveness before applying cost considerations. The process, which includes an evidence-based preferred drug list and supplemental rebates from pharmaceutical manufacturers, is producing savings of about $20 million each year to the state--over 5 percent of its Medicaid fee-for-service drug spending--and about $40 million in combined state-federal spending.
The Medicaid Evidence-Based Decisions Project (MED) is a new collaborative initiative intended to help states make sound decisions about Medicaid coverage and benefits based on evidence of effectiveness and safety.
In February 2005, Pennsylvania struck a deal with the state's four Blue Cross Blue Shield plans that is helping to cover uninsured low-income adults in various state health coverage initiatives. The main beneficiary is the adultBasic program, which provides a limited benefit package to uninsured low-income adults, including those with no dependent children.
Illinois' All Kids health insurance program was enacted in November 2005, pre-registration began soon after, and coverage is expected to become effective in July 2006. Championed by Governor Blagojevich, All Kids provides a comprehensive health insurance coverage option to all uninsured children in Illinois.
Maryland's General Assembly voted to require large firms to provide adequate health care coverage for their employees, or contribute to the state's health programs for the poor. In January 2006, the Senate and House overrode Governor Ehrlich's veto of the Fair Share Health Act, which mandates that businesses with more than 10,000 employees spend at least 8 percent of their payroll on health benefits for their employees or pay the state the difference between what they currently pay and 8 percent. This legislation will have a major impact on one employer, Wal-Mart, which is the only large business in the state that spends less than 8 percent of its payroll on health benefits.
The Texas Medication Algorithm Project (TMAP) was designed to ensure consistent and appropriate pharmaceutical-based treatment for individuals with depression, bipolar disorder, and schizophrenia and for children with attention deficit hyperactivity disorder. Since 2004, the program has continued to grow both in and outside of the state.
Rhode Island's Governor Carcieri has proposed to create a new, affordable health plan for small businesses (up to 50 employees) and individuals, with additional subsidies for businesses with mostly low-wage workers. As a condition of doing business with the state, all insurers would be required to offer a SelectCare insurance product.
Massachusetts lawmakers are finalizing an agreement over House and Senate bills to expand coverage for the uninsured. In late 2005, each chamber passed major health reform bills, both of which include Medicaid expansions.
On March 11, the West Virginia House and Senate each approved a bill (HB 4021) intended to move the state toward universal access to health care by 2010. Based largely on a proposal by Governor Manchin and expected (as of March 20) to be signed by him, the bill would expand eligibility in the State Children's Health Insurance Program to children with family income from 200 to 300 percent of the federal poverty level.
The 2006 budget reconciliation bill (S 1932), called the Deficit Reduction Act of 2005, includes provisions expected to reduce Medicaid spending by an estimated $10 billion over the next 10 years. Among the rules that will have an impact on states are tighter restrictions on asset transfers and greater state flexibility to impose premiums and cost-sharing and to change benefit design for certain Medicaid beneficiaries.