Market watch: Medicaid cost containment and access to prescription drugs: States' efforts to contain the rising costs of Medicaid prescription drugs are reducing enrollees' access to needed medications

Health Affairs

Volumn 24, Issue 3, 2005, Pages 780-789

  Cunningham, Peter J ^a  

^a CENTER FOR STUDYING HEALTH SYSTEM CHANGE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

GENERIC DRUG;

ADULT; AGED; ARTICLE; COST BENEFIT ANALYSIS; DRUG COST; EMPLOYEE; FEMALE; HEALTH CARE POLICY; HUMAN; MALE; MEDICAID; MEDICARE; PRESCRIPTION; UNITED STATES; ADOLESCENT; COST CONTROL; ECONOMICS; HEALTH CARE DELIVERY; HEALTH CARE PLANNING; INFORMATION PROCESSING; LEGAL ASPECT; MIDDLE AGED;

ADOLESCENT; ADULT; AGED; COST CONTROL; DATA COLLECTION; DRUG COSTS; FEMALE; HEALTH SERVICES ACCESSIBILITY; HUMANS; MALE; MEDICAID; MIDDLE AGED; STATE HEALTH PLANS; UNITED STATES;

EID: 20044386365     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.24.3.780     Document Type: Article

References (23)

1. B. Bruen and A. Ghosh, Medicaid Prescription Drug Spending and Use (Washington: Kaiser Commission on Medicaid and the Uninsured, June 2004).
2. J.S. Crowley, D. Ashner, and L. Elam, Medicaid Outpatient Prescription Drug Benefits: Findings from a National Survey, 2003 (Washington: Kaiser Commission, 2003).
3. J.S. Crowley, D. Ashner, and L. Elam, Medicaid Outpatient Prescription Drug Benefits: Findings from a National Survey, 2003 Ibid 2003.
4. C.E. Reeder and A.A. Nelson, "The Differential Impact of Copayment on Drug Use in a Medicaid Population," Inquiry 22, no. 4 (1985): 396-403;
5. B. Stuart and C. Zacker, "Who Bears the Burden of Medicaid Drug Copayment Policies?" Health Affairs 18, no. 2 (1999): 201-212;
6. S. Soumerai et al., "Payment Restrictions for Prescription Drugs under Medicaid: Effects on Therapy, Cost, and Equity," New England Journal of Medicine 317, no. 9 (1987): 550-556;
7. and A.A. Nelson, C.E. Reeder, and W.M. Dickson, "The Effect of a Medicaid Drug Copayment Program on the Utilization and Cost of Prescription Services," Medical Care 22, no. 8 (1984): 724-736.
8. P.J. Cunningham, Affording Prescription Drugs: Not Just a Problem for the Elderly (Washington: Center for Studying Health System Change, April 2002).
9. R. Strouse, B. Carlson, and J. Hall, Community Tracking Study: Household Survey Methodology Report 2000-01 (Round Three), Technical Publication no. 46, July 2003, www.hschange.com/CONTENT/602/602.pdf (16 February 2005).
10. Crowley et al., Medicaid Outpatient Prescription Drug Benefits;
11. and R. Schwalberg et al., Medicaid Outpatient Prescription Drug Benefits: Findings from a National Survey and Selected Case Study Highlights (Washington: Kaiser Commission, October 2001).
12. A notable exclusion from these five policies is the use of preferred drug lists (PDLs), which are excluded because they were ascertained in the 2003 Kaiser Family Foundation survey but not the 2000 survey, whereas the five policies included in the analysis were ascertained in both surveys. PDLs are in many ways a variant of prior authorization (prior authorization is needed for drugs not on the list), and therefore the exclusion is unlikely to have any major effects on results. In fact, separate analyses of 2003 data only (based on the methodology described below) did not find any independent effect of PDLs on prescription drug access.
13. In some states, the use of generics is encouraged (but not required) through the use of differential copayments, differential dispensing fees, and provider education. The measure in this study reflects only states that require generics as the most restrictive form of cost containment policies.
14. Adjusted means were computed from ordinary least squares (OLS) regression using the 2003 survey data, with access as the dependent variable and insurance coverage and other individual characteristics as independent variables.
15. Although a probit or logistic regression is normally used when the dependent variable is binary, OLS regression was used in this analysis because the coefficients reflected linear probabilities and were therefore easier to interpret. Results from a logistic regression analysis produced very similar results.
16. The analysis focused on comparing states that have implemented four or five policies with states that implemented three or fewer. There were too few states that had implemented no policies to analyze separately, and earlier versions of the analysis show that there were no differences in access between states with two or fewer policies and states with three policies.
17. Dual eligibles are people who are eligible for both Medicaid and Medicare. Binary variables for each state were included to control for all other state-level factors that could potentially confound the effects of cost containment policies on prescription drug access. A similar indicator for survey year was included to account for all other secular changes in access not accounted for by the variables in the model.
18. J.F. Hoadley, L.E. Felland, and A.B. Staiti, Federal Aid Strengthens Health Care Safety Net: The Strong Get Stronger, Issue Brief no. 80 (Washington: HSC, April 2004).
19. J. Tilly and L. Elam, Prior Authorization for Medicaid Prescription Drugs in Five States: Lessons for Policy Makers (Washington: Kaiser Commission, April 2003).
20. Soumerai et al., "Payment Restrictions";
21. and Reeder and Nelson, "The Differential Impact of Copayment."
22. C. Fahlman, B. Stuart, and C. Zacker, "Community Pharmacist Knowledge and Behavior in Collecting Drug Copayments from Medicaid Recipients," American Journal of Health System Pharmacy 58, no. 5 (2001): 389-395.
23. Tilly and Elam, Prior Authorization.