Medicaid Payment Amount — Rx

This variable is contained in the following files:

Medicare-Medicaid Linked Enrollee Analytic Data Source 3.0

SAS Name

MDCD_RX_TOTAL_SPEND

This variable is the total Medicaid payment amount from all pharmacy (RX) claims for the beneficiary during the year. Note that this dollar amount may be an undercount if the beneficiary had managed care claims.

Comments

CCW calculates this variable as the sum of all MDCD_PD_AMT from the Pharmacy (header) claims. The Center for Medicaid and CHIP Services (CMCS) at CMS has required redaction of this payment field for managed care claims due to the proprietary and confidential nature of this information. Therefore, when summing Medicaid expenditures using the claim files it is important to keep in mind that totals will not reflect the redacted managed care expenditures.

MMLEADS counts all claims in the MDCD_RX_TOTAL_USE variable. Use caution when calculating average spend per claim. There may be claims (i.e., use) for which there is no corresponding payment information.

Values: $

Source: T-MSIS Pharmacy Claims file (derived)