. 2013 Mar 28;3(1):mmrr.003.01.b01. doi: 10.5600/mmrr.003.01.b01

Exhibit 7. Summary of the 2008 MAX Encounter RX Claims.

	State Has Comprehensive Managed Care (CMC)^a	Percentage of CMC Enrollees Met Threshold^b				State Submitted RX Encounter Claims^c				RX Encounter Records Are Complete^d				RX Encounter Records Are of Comparable Quality to FFS Data^e				RX Encounter Data Are Usable for Research^f
		A	C	D	E	A	C	D	E	A	C	D	E	A	C	D	E	A	C	D	E
Alabama
Alaska
Arizona	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Arkansas
California	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Colorado	X	X	X	X	X
Connecticut
Delaware
DC	X	X	X	X
Florida	X	X	X	X	X	X	X		X				X	X	X		X				X
Georgia	X	X	X			X	X			X	X			X	X			X	X
Hawaii	X	X	X	X
Idaho
Illinois
Indiana	X	X	X	X		X	X	X		X	X	X		X	X	X		X	X	X
Iowa
Kansas	X	X	X			X	X			X	X			X	X			X	X
Kentucky	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Louisiana
Maine
Maryland	X	X	X	X		X	X	X		X	X	X		X	X	X		X	X	X
Massachusetts	X	X	X	X
Michigan	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Minnesota	X	X	X	X	X	X	X	X	X	X	X		X
Mississippi
Missouri	X	X	X			X	X			X	X			X	X			X	X
Montana
Nebraska
Nevada	X	X	X
New Hampshire
New Jersey^g
New Mexico	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
New York^g
North Carolina
North Dakota
Ohio	X	X	X	X	X
Oklahoma
Oregon^g
Pennsylvania	X	X	X	X	X
Rhode Island	X	X	X	X		X	X	X		X	X	X		X	X	X		X	X	X
South Carolina	X	X	X	X
South Dakota
Tennessee
Texas
Utah
Vermont	X
Virginia	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X	X
Washington	X	X	X				X				X				X				X
West Virginia
Wisconsin^g
Wyoming
Total	24	23	23	18	11	14	15	10	8	13	14	9	8	13	14	9	7	12	13	9	7

NOTE. A=Adults, C=Children, D=Disabled, E=Aged.

At least one percent of enrollees participated in HMO/HIO/PACE at some point during 2008. There were 12 states in which MC plans did not provide a pharmacy benefit: CT, DE, IA, IL, NE, NJ, NY, OR, TN, TX, WI, and WV (Bagchi, Verdier, & Esposito, 2012).

At least 10 percent of enrollees in the BOE participated in HMO/HIO at some point during the year.

In addition to having at least 10 percent HMO/HIO participation, the state submitted at least 200 encounter claims for the BOE.

The BOE-specific metric was met for at least one of the two completeness measures: (1) percentage of enrollees with RX encounter claims and (2) average number of RX encounter claims per enrollee.

The BOE-specific metric was met for at least one of the two quality measures: (1) percentage of RX claims with date prescribed and (2) percentage of RX claims with quantity.

Both the completeness and quality standards were met for the BOE.

NJ, NY, OR, and WI submitted RX encounter data even though prescription drugs were not included in the HMO benefit package. Bagchi et al., (2012) identify which states "carved out" their pharmacy benefits.

SOURCE: Mathematica's analysis of the MAX 2008 PS and RX files.