MCM Pharmacy Report
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- All rates in this report are at the Managed Care program level.
- Contract standards are noted when applicable.
- All measures default to the last 5 data points.
- Select the performance measure name for more information (e.g. charts, MCO rates, measure description)
Pharmacy Utilization
- Unit = Percent
- For more detail on all other performance measures, select the name for more information (e.g. charts, MCO rates, measure description)
- Use the following link for more detail on the PDL utilization.
Tables
| Measure Name Sort descending | Mar 2024 | Jun 2024 | Sep 2024 | Dec 2024 | Mar 2025 | Contract Requirement | Year |
|---|---|---|---|---|---|---|---|
| Pharmacy Utilization Management: Generic Drug Substitution | 99.0 | 99.0 | 99.1 | 99.2 | 99.2 | ||
| Pharmacy Utilization Management: Generic Drug Utilization | 89.7 | 89.6 | 89.1 | 88.6 | 88.5 | ||
| Pharmacy Utilization Management: Generic Drug Utilization Adjusted for Preferred PDL Brands | 91.1 | 90.8 | 90.3 | 89.8 | 89.1 |
Pharmacy Claims Processing
- Unit = Minutes
- Select the performance measure name for more information (e.g. charts, MCO rates, measure description)
Tables
Pharmacy Service Authorizations
- Unit = Percent
- Select the performance measure name for more information (e.g. charts, MCO rates, measure description)
- Select this link for more detail on service authorizations by classes.
Tables
| Measure Name Sort descending | Sep 2017 | Dec 2017 | Mar 2018 | Jun 2018 | Sep 2018 | Dec 2023 | Mar 2024 | Jun 2024 | Sep 2024 | Dec 2024 | Contract Requirement | Year |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pharmacy Service Authorization Timely Determination Rate | 99.9 | 100.0 | 100.0 | 99.9 | 100.0 | 100.0 | SFY 2025 | |||||
| Pharmacy Prior Authorizations Requests By Behavioral Health and Non-Behavioral Health Therapeutic Drug Classes | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
Polypharmacy Medication Review & Quality Improvement Initatives
- The unit for these measures is percent. For the Maintenance Medication Gaps and High Risk Medications in the Eldery measures, a lower number indicates higher performance.
- Select the performance measure name for more information (e.g. charts, MCO rates, measure description)
Tables
‡ Data has been suppressed due to small sample size.