Medicaid Prescription Drug Management Quality Scores Analysis

This technical report produced for the Elevance Health Public Policy Institute compares pharmacy-related quality outcomes of Medicaid managed care organizations (MCOs) under two policy frameworks: the carve-in model, where MCOs manage pharmacy benefits, and the carve-out model, where they do not. The report aims to assess the hypothesis that a more integrated pharmacy benefit leads to better quality outcomes. The analysis utilizes the NCQA Quality Compass data set, focusing on 29 pharmacy-related HEDIS measures from 2014 to 2020. Findings indicate that MCOs in carve-in states consistently achieved higher HEDIS scores compared to those in carve-out states, with 97% of comparisons favoring the carve-in model. The report also examines the impact of Preferred Drug List latitude on quality scores, revealing that MCOs with greater management flexibility reported the most favorable outcomes. Detailed comparisons and methodologies are outlined in subsequent sections, providing a comprehensive view of the quality performance across different Medicaid pharmacy management approaches.