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Cost Transparency Board: data show pharmacy prices and outpatient care drove recent spending growth
Summary
HCA's cost-driver analysis, presented to the Cost Transparency Board, attributes most recent per-member spending growth to retail pharmacy price increases and higher outpatient and "other medical" spending; staff committed to deeper dives into pharmacy utilization measures, regional variation and member out-of-pocket impacts.
HCA staff presented a first-look cost-driver analysis based on the state All-Payer Claims Database, finding that retail pharmacy, outpatient services and a catchall "other medical" category are the largest contributors to per-member, per-month (PMPM) spending increases.
The data team said the APCD-based analysis covers roughly 71% of the state population and allows granular review of utilization and allowed amounts, though it excludes Medicare fee-for-service through 2023. "Pharmacy growth is heavily price intensity driven," Kathy Temple, senior data analyst, told the board, summarizing charts that show a post-pandemic acceleration in allowed amounts per pharmacy fill across…
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