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High-Cost Drugs and the Medicaid Program: MACPAC Evidence and Recommendations

While Medicaid drug spending is growing, it is increasingly driven by high-cost specialty drugs. In fiscal year (FY) 2021, Medicaid spent approximately $80.6 billion on outpatient prescription drugs and collected $42.5 billion in rebates, bringing net drug spending to $38.1 billion. In FY 2021, drugs over $1,000 per claim accounted for less than 2 percent of utilization but more than half of Medicaid spending.

MACPAC’s work has been focused on how to address states’ concerns about the growing costs associated with specialty drugs, as well as how to ensure that beneficiaries who could benefit from these new therapies would still have access to them. Our Policy in Brief has quick facts and a summary of MACPAC evidence and recommendations to date related to high-cost drugs and the Medicaid program.