The Highest Cost Medicaid Enrollees with Sickle Cell Disease Had Annual Health Care Expenditures Nearing $200 000

Abstract

Sickle cell disease (SCD) is a painful chronic blood disorder that causes serious complications and comorbidities, often leading to premature death. SCD impacts millions of people worldwide, including an estimated 100 000 in the United States, most of whom are Black or Latino. We analyzed Medicaid enrollment, claims, and encounter data via the Transformed Medicaid Statistical Information System (T-MSIS) to examine the 2021 health care utilization and spending of Medicaid enrollees with SCD. Our analysis found that Medicaid enrollees with SCD have high annual medical and pharmacy expenditures that are not evenly distributed across the population. Among the most severe, clinical trial eligible enrollees, those in the top 5% of health care spending incurred, on average, nearly $200 000 per year for this chronic condition.