No abstract

This research longitudinally examines the association between levels of state Medicaid prescription spending and the state strategies intended to constrain cost increases: the negotiated pricing strategy, as indicated by state rebate programs, and the price transparency strategy, as indicated by state operation of All-Payer Claims Databases. The findings demonstrate evidence that state Medicaid prescription spending is influenced by the negotiated pricing strategy, especially Managed Care Organization (MCO) rebates under the Patient Protection and Affordable Care Act, but not influenced by the price transparency strategy. State decisions for MCO rebates, such as carving prescription benefits into managed care benefits, were effective in containing levels of Medicaid prescription spending over time, while other single- and multi-state rebate programs were not. Based on these findings, state policymakers may consider utilizing the MCO rebate program to address increases in Medicaid prescription spending.

Initial state implementation of the Affordable Care Act health exchanges was marked by political polarization. More than half of the states initially chose not to create their own health exchanges, leading the federal government to adopt a new strategy: dividing the implementation of health exchanges into a series of smaller tasks. States could choose which of four core functions of the exchanges they would implement, with the federal government handling the remaining functions. This strategy induced some resistant states to administer some core functions. Why did some states take part in the exchanges while others did not? Ordered logistic regression analyses provide evidence that both state political context and other factors affected this decision. The analyses also suggest that state officials considered state workforce capacity and financial inducements from the federal government and that they were influenced by divided government.