John joined the N.C. Division of Medical Assistance (DMA) as Director of Pharmacy and DMEPOS Programs in October 2014. John holds a Bachelor of Pharmacy degree from the UNC Eschelman School of Pharmacy. His impressive 30+ years experience in management of hospital, long-term care and retail pharmacy and DME demonstrates his knowledge of the industry. As Senior Account Manager for a national leader in providing pharmacy benefits management services to state Medicaid agencies, he led various pharmacy program initiatives and accounts for many Medicaid agencies across the United States. John’s extensive background in Prior Authorizations, Medication Management Programs and Preferred Drug List aligns with the N.C. DMA’s initiatives.
The NC Medicaid Pharmacy Program provides prescription drug coverage to more than 2 million Medicaid and Health Choice beneficiaries, and to individuals enrolled in both Medicaid and Medicare.
Prescription drugs play a significant and increasing role in maintaining health and treating illnesses, giving our beneficiaries the opportunity to become healthier and improve their quality of life. While groundbreaking research continues to lead to new and more effective medications to address a wider range of diseases, many have a significant cost. The N.C. DMA Pharmacy Program staff work proactively to balance health of beneficiaries and the cost of care.
Since SFY 2014 gross pharmacy expenditures have increased 26.7%, exceeding $1.96B in SFY 2018 and representing 13.5% of total Medicaid expenditures. However, net pharmacy expenditures have decreased 7.9% during the same time-period to ~$727M representing 5% of total Medicaid expenditures. This decrease in net pharmacy expenditures is primarily due to a significant increase in drug rebates which exceeded $1.2B and representing 62.9% of gross pharmacy expenditures in SFY 2018.
Pharmacy program management through careful selection of drugs on the NC Medicaid Preferred Drug List (PDL) and maximizing drug rebates are among the ways the NC Medicaid provides access to the right drugs at the most advantageous cost. The result is a pharmacy program that provides the best overall value to beneficiaries, providers and the State.