233 Effects of Medication Management on Cost and Utilization among Medicaid Beneficiaries in Nebraska

W.R. Doucette; B. Alabi; L. Polgreen; S. Hubert

doi:10.1016/j.japh.2026.103265

Objectives Community pharmacies have been working to expand the care services they provide to their patients. In particular, networks of community pharmacies aligned as Community Pharmacy Enhanced Service Networks (CPESNs) have been contracting with payers to deliver medication management services to populations in need (e.g., complex patients). A key question of interest to payers is how medication management services affect patient outcomes such as utilization and costs of care. Nebraska Enhanced Services Pharmacies (NESP), a CPESN in Nebraska, has arranged a contract to deliver comprehensive medication management services for complex Medicaid beneficiaries with a managed care organization (MCO) in Nebraska. The program targeted beneficiaries on six or more maintenance medications as identified by the plan. Services provided were comprehensive medication review, medication reconciliation with members, multi-dose adherence packaging, monthly contacts with members and delivery service. The objective of this study was to assess how the NESP medication management services affected utilization and total costs of care of the Medicaid beneficiaries of the MCO. Methods Data for this retrospective study were obtained from Nebraska Total Care Medicaid claims data from January 2023 to December 2024. The final sample included pharmacy-engaged beneficiaries with a minimum of 6 months enrollment (at least 3 months continuous enrollment prior pharmacy engagement and 3 months after). Three costs categories were identified for this analysis: medical costs, pharmacy costs and total costs, which is the sum of medical and pharmacy costs. A pharmacy service program enrollment date was used to categorize claims into pre-enrollment utilization and costs and post-enrollment utilization and costs. Average monthly pre-enrollment and post-enrollment costs were compared using Generalized Linear Mixed Models (GLMMs). Similarly, average monthly pre- and post-enrollment inpatient hospitalizations, emergency department visits and primary care use were compared using GLMMs. All models were adjusted for demographic characteristics and comorbidity counts. Results The final sample comprised 500 enrollees; 64% were females, 62% had residence in rural locations and the median age was 46 years (IQR 36-57). With a median total enrollment period of 24 months, average monthly medical, pharmacy, and total costs decreased significantly following pharmacy engagement. Medical costs decreased by 46%, pharmacy costs by 14%, and combined costs by 33%. For example, a pre-engagement average monthly total cost of $1,300 could decrease to about $858 following pharmacy engagement. This translates to an annual cost savings of about $5,300 per beneficiary. The analysis also revealed significant decreases in inpatient hospital stays, emergency visits and primary care use (decrease of 59%, 38% and 25% respectively). Conclusions/Implications A medication management program delivered by CPESN member pharmacies was associated with reduced costs of care for a group of Medicaid beneficiaries. Community pharmacies tend to see their patients often, compared to other providers. This regular access supports pharmacists working with patients to monitor the effects of medication therapy and assure proper medication adherence. Further trial and evaluation of such programs is encouraged.

233 Effects of Medication Management on Cost and Utilization among Medicaid Beneficiaries in Nebraska

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