Medicaid Changes Could Reshape Drugmaker Access and Revenue
A new HMA brief examines how the 2025 budget reconciliation law's Medicaid changes could alter medication access and financial exposure for pharmaceutical manufacturers. It warns that state implementation choices and eligibility disruptions may interrupt treatment continuity even among beneficiaries who remain eligible. HMA's claims analysis put 2024 gross Medicaid pharmacy spending at about $118.6 billion, including $42.4 billion for expansion adults.
A new HMA issue brief assesses how the 2025 reconciliation law—often called H.R. 1 or OBBBA—may affect Medicaid medication access and manufacturer revenue. It notes that federal and state choices around eligibility, work requirements, and exemptions could disrupt care even for people who still qualify.
Using 100% Medicaid/T-MSIS claims, HMA estimated 2024 gross Medicaid pharmacy spending at about $118.6 billion before rebates. Expansion adults accounted for $42.4 billion, or 35.8%, and five brands made up 21% of that group’s pharmacy spending, with exposure concentrated in diabetes, behavioral health, HIV, oncology, and autoimmune treatments.
The changes could affect low-income Medicaid enrollees who rely on steady drug treatment, especially those with diabetes, behavioral health conditions, HIV, cancer, or autoimmune disease. Administrative churn may interrupt refills or therapy starts even when eligibility remains, while manufacturers and patient-support programs could face added uncertainty. State implementation choices may therefore shape whether care continues smoothly and how much financial risk shifts across patients, providers, plans, and drugmakers.