Who bears the burden of medicaid drug copayment policies?

Health Affairs

Volumn 18, Issue 2, 1999, Pages 201-212

  Stuart, Bruce ^a   Zacker, Christopher ^b  

^a UNIVERSITY OF MARYLAND SCHOOL OF PHARMACY   (United States)

^b NOVARTIS PHARMA AG   (Switzerland)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; COST; CROSS-SECTIONAL STUDY; DRUG COST; DRUG UTILIZATION; ECONOMICS; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH INSURANCE; HUMAN; MEDICAID; REGRESSION ANALYSIS; UNITED STATES;

AGED; COST SHARING; CROSS-SECTIONAL STUDIES; DRUG COSTS; DRUG UTILIZATION; HEALTH EXPENDITURES; HEALTH POLICY; HUMANS; INSURANCE, PHARMACEUTICAL SERVICES; MEDICAID; REGRESSION ANALYSIS; UNITED STATES;

EID: 0033092323     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.2.201     Document Type: Article

References (18)

1. Pharmaceutical Benefits under State Medicaid Programs (Reston, Va.: National Pharmaceutical Council, 1996), 3-24.
2. S. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine (27 August 1987): 550-556; S. Soumerai et al., "Effects of Limiting Medicaid Drug-Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine (8 September 1994): 650-655; and S. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admissions to Hospitals and Nursing Homes," New England Journal of Medicine (10 October 1991): 1072-1077.
3. S. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine (27 August 1987): 550-556; S. Soumerai et al., "Effects of Limiting Medicaid Drug-Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine (8 September 1994): 650-655; and S. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admissions to Hospitals and Nursing Homes," New England Journal of Medicine (10 October 1991): 1072-1077.
4. S. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine (27 August 1987): 550-556; S. Soumerai et al., "Effects of Limiting Medicaid Drug-Reimbursement Benefits on the Use of Psychotropic Agents and Acute Mental Health Services by Patients with Schizophrenia," New England Journal of Medicine (8 September 1994): 650-655; and S. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admissions to Hospitals and Nursing Homes," New England Journal of Medicine (10 October 1991): 1072-1077.
5. C. Reeder and A. Nelson "The Differential Impact of Copayment on Drug Use in a Medicaid Population," Inquiry (Winter 1985): 396-403; and E. Brian and S. Gibbens, "California's MediCal Copayment Experiment," Medical Care (December 1976): 1014-1023.
6. C. Reeder and A. Nelson "The Differential Impact of Copayment on Drug Use in a Medicaid Population," Inquiry (Winter 1985): 396-403; and E. Brian and S. Gibbens, "California's MediCal Copayment Experiment," Medical Care (December 1976): 1014-1023.
7. 42 CFR, 447.53.
8. Twelve of the thirty-eight states were represented by fewer than ten MCBS respondents each; twenty had between eleven and fifty respondents; four had between fifty-one and one hundred; and two had more than 100.
9. Pharmaceutical Benefits under State Medical Assistance Programs, 1992 (Reston, Va.: National Pharmaceutical Council, 1992).
10. The MCBS is a public-use file with names and addresses encoded to protect recipients' confidentiality. Our research protocol gave us access to respondents' ZIP codes, from which we were able to determine state of residence.
11. Medicare Current Beneficiary Survey, CY 1992 Cost and Use Public Use Documentation (Baltimore: Health Care Financing Administration, 1996).
12. W. Manning et al., "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review (June 1987): 251-277.
13. Models with dichotomous dependent variables were estimated with logistic regression. Ordinary least squares was used to estimate the expenditure and prescription count regressions. The regression results can be obtained from Bruce Stuart, University of Maryland School of Pharmacy, Room 613,100 N. Green Street, Baltimore, Maryland 21201. We examined the robustness of these results to alternative model specification, including, where appropriate, linear probability, Poisson regression, and log-linear models. We also estimated a series of fixed-effects models with state-level dummies to control for intrastate correlations among sample respondents. Because the state-level samples were unequal in size, states with the largest numbers are given greater weight in the estimates. This conceivably could bias the findings toward reflections of peculiarities of these states as opposed to the influence of copayments more generally. We performed extensive correlation tests of state policies to attempt to detect such potential bias and could find none. Indeed, none of the major findings reported here was sensitive to model specification.
14. See, for example, B. Stuart and J. Grana, "Ability to Pay and the Decision to Medicate," Medical Care (February 1998): 202-211; B. Stuart and J. Grana, "Are Prescribed and Over-the-Counter Medicines Economic Substitutes? A Study of the Effects of Health Insurance on Medicine Choices by the Elderly," Medical Care (May 1995): 487-501; and B. Stuart and N.E. Coulson, "Insurance Choice and the Demand for Prescription Drugs," Southern Economic Journal (April 1995): 1146-1157.
15. See, for example, B. Stuart and J. Grana, "Ability to Pay and the Decision to Medicate," Medical Care (February 1998): 202-211; B. Stuart and J. Grana, "Are Prescribed and Over-the-Counter Medicines Economic Substitutes? A Study of the Effects of Health Insurance on Medicine Choices by the Elderly," Medical Care (May 1995): 487-501; and B. Stuart and N.E. Coulson, "Insurance Choice and the Demand for Prescription Drugs," Southern Economic Journal (April 1995): 1146-1157.
16. See, for example, B. Stuart and J. Grana, "Ability to Pay and the Decision to Medicate," Medical Care (February 1998): 202-211; B. Stuart and J. Grana, "Are Prescribed and Over-the-Counter Medicines Economic Substitutes? A Study of the Effects of Health Insurance on Medicine Choices by the Elderly," Medical Care (May 1995): 487-501; and B. Stuart and N.E. Coulson, "Insurance Choice and the Demand for Prescription Drugs," Southern Economic Journal (April 1995): 1146-1157.
17. M.L. Berk, C.L. Schur, and P. Mohr, "Using Survey Data to Estimate Prescription Drug Costs," Health Affairs (Fall 1990): 146-156.
18. Soumerai et al., "Payment Restrictions for Prescription Drugs."