WASHINGTON — The cost of Medicaid can be cut with benefit modification, more effective care management and more efficient drug purchasing.

That is the message of a letter from National Association of Chain Drug Stores president and chief executive officer Steve Anderson to Department of Health and Human Services Secretary Kathleen Sebelius.

Anderson urges states to make cost sharing mandatory for beneficiaries, as permitted by federal law. Currently, pharmacies cannot deny service to beneficiaries who refuse to pay their co-payments, unless states request this authority through the State Plan Amendment process.

“Cost sharing loses its effectiveness as a means to influence behavior when beneficiaries have no obligation to pay co-payments,” he says.

Better coordination of care for high-cost beneficiaries provides a tremendous opportunity to reduce spending, Anderson adds. Poor medication adherence costs the United States about $290 billion annually, or 13% of total health care costs.

“Poor adherence often leads to preventable worsening of disease, posing serious and unnecessary health risks, particularly for patients with chronic illnesses,” he says.

“Community pharmacists can play a critical role in health homes and other coordinated care models, improving patient care by promoting safe and effective medication use. Highly accessible and medication experts, local pharmacists can work in the health home to help achieve optimal patient outcomes.”

For every 1% increase in generics utilization, a Medicaid program can save $468 million, Anderson notes. Massachusetts has the highest generics dispensing rate in the nation, at 79.3%. If other states could match it, Medicaid could save $5.14 billion nationally.

“We believe that there are many best practices that could be put in place to reduce Medicaid spending,” Anderson wrote in the letter.