The National Medicaid Pooling Initiative (NMPI)
Operational since 2003. At present, 10 states—Alaska, Kentucky, Michigan, Minnesota, Montana, New Hampshire, New York, North Carolina, Rhode Island and South Carolina—plus the District of Columbia participate. NMPI covers 3.8 million people and has supplemental rebate agreements with more than 90 pharmaceutical manufacturers.
The Top Dollar Program (TOP$)
Starting with two member states in 2005, there are now six participating states: Connecticut, Idaho, Louisiana, Maryland, Nebraska and Wisconsin.
The Sovereign States Drug Consortium (SSDC)
Founded as a non-profit structure in 2005, 13 states take part in the SSDC: Delaware, Iowa, Maine, Mississippi, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Utah, Vermont, West Virginia and Wyoming. Collectively, the consortium covers 10 million people.
The Northwest Prescription Drug Consortium (NPDC)
The NPDC is an intergovernmental agreement between Nevada, Oregon and Washington which provides broad pharmacy management services, operating under a single pharmacy benefit manager (PBM), which generates additional savings by aligning purchasing through one vehicle and leveraging those states purchasing power. Entities from both the private and public sector are eligible to join. Notably, the NPDC requires 100% pass-through of all manufacturer rebates and prohibits spread pricing.
Additionally, it provides a discount card program to residents in those states. Discounts are applied point-of-sale at participating locations. According to the consortium’s website, the NPDC facilitates more than $800 million in annual drug purchases for over 1 million people in participating groups and facilities. Since 2016, the program generated over $99.4 million in additional savings.
The Minnesota Multistate Contracting Alliance for Pharmacy (MMCAP)
Founded in the mid-1990s, MMCAP is a group purchasing organization that combines the purchasing power of state agencies (such as public health departments), counties, cities and school districts in all 50 states to generate additional savings on pharmaceuticals and healthcare products. It does not include state Medicaid purchasing.
Instead of pooling resources with other states, some lawmakers are consolidating the purchasing clout within their own borders. Created in 2019, New Mexico’s Interagency Pharmaceutical Purchasing Council is tasked with identifying strategies to leverage the collective purchasing power of the state’s agencies—including corrections, state employees and retirees, counties, public schools and universities—and report their findings annually to the legislature. Legislators use the information to inform fiscal policy in the state.
California embarked on a similar path in 2019 and, by executive order, required state agencies—including Medi-Cal, the state Medicaid agency covering 12 million people—to implement a combined drug procurement strategy. Implementation is in initial stages and, according to the California Legislative Analyst office, the potential savings generated could be hundreds of millions of dollars.