Medicaid MCOs: Contracting Landscape and Manufacturer Competitive Assessment

Medicaid MCOs: Contracting Landscape and Manufacturer Competitive Assessment

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Despite uncertainty surrounding federal legislative changes, partnerships with Medicaid MCOs remain critical to maintaining access as the market segment continues to expand. HIRC's report, Medicaid MCOs: Contracting Landscape and Manufacturer Competitive Assessment, reviews Medicaid MCO pharmacy and medical directors' evaluation of manufacturers, and focuses on trends in contracting. The report addresses the following questions:

  • Which manufacturers are most often nominated as MCOs' overall "Partner of Choice"?
  • Which manufacturers lead in Medicaid MCO executives' evaluation of willingness to offer supplemental rebates?
  • Which manufacturers lead in Medicaid MCO executives' evaluation of quality of programs and/or resources? What is the level of customer-facing access?
  • Which contract types are most commonly offered for traditional, specialty, and oncology medications? Which are the most preferred?
  • What program opportunities exist for manufacturers to distinguish themselves as valued partners?

Key Finding: Opportunities for firms to meaningfully engage with Medicaid MCOs include quality initiatives, population health management, and comparative effectiveness research.

Gilead and Novo Nordisk Rate Highest in Level of Customer-Facing Access. Respondents were asked to consider and rate 41 pharmaceutical firms on the level of access each manufacturers' customer-facing personnel has to their key decision makers (KDMs). Medicaid MCO panelists report that Gilead has the highest level of customer-facing access to KDMs, followed by Novo Nordisk.

The complete listing of companies is provided in the full report, along with year-over-year ratings and customer comments.

Medicaid MCOs Most Prefer Flat Access Rebates Tied to Preferred Position. Respondents were asked to consider five different contract types and select one as most preferred. Nearly half (46%) of panelists selected flat access rebates tied to preferred position as the most preferred contract type. The ease of administration and management, in combination with savings, encompass the underlying value of this contract type to Medicaid MCO executives.

Opportunities for Partnership Examined. Medicaid MCO executives were asked to consider and rate their interest as well as the current availability of a variety of manufacturer program/resource offerings. Gap analyses reveal reducing hospital readmissions, support for improving CAHPS scores, population health management, and appropriate drug utilization are areas where customer interest and perceived availability of support offerings are not in sync.

Research Methodology and Report Availability. In September 2017, HIRC surveyed 37 Medicaid MCO pharmacy and medical directors from national, regional, and BCBS plans. Online surveys and follow-up telephone interviews were used to gather information. The complete report, Medicaid MCOs: Contracting Landscape and Manufacturer Competitive Assessment, is available now to HIRC’s Managed Markets subscribers at www.hirc.com.

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