Virginia Medicaid has reported 'obscene' overspending on prescription drugs for years, analysis shows

CBS News 6 Richmond

Reporter: Tyler Layne

Strategic Directions VA Medicaid Report https://www.strategicdirectionsrx.com/vamedicaid

New research published by a group of pharmacists is raising concerns about Virginia's reported overspending on drugs for Medicaid patients. However, the state is pushing back against the findings, citing inaccurate spending data that it has been submitting to the federal government for several years.

The report was done by Strategic Directions Rx, a healthcare consultant group, and Pharmacists United for Truth and Transparency, an organization that advocates for independent pharmacists.

The report's author, pharmacy owner and data analyst Jeremy Counts, said the findings indicate a troubling trend of the Department of Medical Assistance Services (DMAS), the state Medicaid agency, reportedly overpaying for medications at pharmacies and outpatient facilities.

“We've got elevated spending on prescription drugs to levels that are obscene, but we've got pharmacies closing down everywhere. We've got providers who can't stay open because they're getting under-reimbursed," Counts said. “It's alarming, and we've got to get a hold on it right now, or things are going to get much, much worse.”

Counts analyzed data that DMAS submitted to the Centers for Medicare and Medicaid Services (CMS) from 2017-2023. During that time, he found Virginia reportedly overspent by $10.86 billion on drugs compared to other states.

In 2023 alone, he concluded Virginia reportedly spent roughly $2,600 on drugs per Medicaid enrollee, which was four times higher than the national average of $555... Continue Reading