A letter report issued by the Government Accountability Office with an abstract that begins "Medicare Advantage (MA) organizations' actual medical expenses, nonmedical expenses (such as marketing, sales, and administration) and profits as a percentage of total revenue were, on average, similar to projected values for plans available to all beneficiaries in 2011, the most recent year for which data were available at the time of the request for this work. MA organizations' actual medical expenses, nonmedical expenses, and profits were 86.3 percent, 9.1 percent, and 4.5 percent of total revenue, respectively. As a percentage of revenue, all three categories were within 0.3 percentage points of what MA organizations had projected. In addition, MA organizations received, on average, $9,893 in total revenue per beneficiary, slightly higher than the projected amount of $9,635."

A letter report issued by the Government Accountability Office with an abstract that begins "To develop a national benchmark for retail pharmacy acquisition costs of Medicaid covered outpatient prescription drugs--known as the National Average Drug Acquisition Cost (NADAC)--the Centers for Medicare & Medicaid Services (CMS) within the Department of Health and Human Services (HHS) surveys each month randomly selected retail community pharmacies for invoice data on their actual drug acquisition costs. CMS then calculates an average acquisition cost for each drug based on invoice data received from about 500 to 600 pharmacies. CMS officials expressed confidence in their current process, but noted that some limitations may exist. For example, CMS officials stated the extent to which NADACs reflect rebates and discounts is limited because most occur off-invoice or are not tied to a specific drug purchase. CMS has developed and published more than 5,000 NADACs, which CMS has estimated apply to more than 90 percent of the drug claims reimbursed by Medicaid."

Correspondence issued by the Government Accountability Office with an abstract that begins "Special needs plans (SNP) reported having higher profit margins and spending a lower percentage of total revenues on medical expenses, on average, than Medicare Advantage (MA) plans available to all beneficiaries in 2011. For instance, SNPs' average profit margin was 4.0 percentage points higher than plans available to all beneficiaries--8.6 percent vs. 4.6 percent. SNPs also had a higher plan-level median profit margin compared to MA plans available to all beneficiaries--7.1 percent vs. 3.2 percent. All three types of SNPs--dual-eligible SNPs, chronic condition SNPs, and institutional SNPs--spent, on average, a lower percentage of total revenue on medical expenses and had higher profit margins relative to MA plans available to all beneficiaries. SNPs also spent a lower percentage of total revenue on medical expenses and had higher profit margins relative to MA plans available to all beneficiaries after accounting for whether a plan had a high or low enrollment-weighted average benchmark--the maximum amount Medicare will pay plans to serve an average beneficiary in a given area. Similarly, SNPs spent a lower percentage of total revenue on medical expenses and had higher profit margins relative to MA plans available to …