Making a case for employing a societal perspective in the evaluation of Medicaid prescription drug interventions

PharmacoEconomics

Volumn 26, Issue 4, 2008, Pages 281-296

  Roy, Sanjoy ^a,b   Madhavan, S Suresh ^a  

^a WEST VIRGINIA UNIVERSITY   (United States)

^b WEST VIRGINIA UNIVERSITY   (United States)

Author keywords

Drug utilisation; Formularies; Healthcare expenditure

Indexed keywords

ANALGESIC AGENT; ANTIINFECTIVE AGENT; ANTIULCER AGENT; CEFACLOR; CYCLOOXYGENASE 2 INHIBITOR; HISTAMINE H2 RECEPTOR ANTAGONIST; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; NEUROLEPTIC AGENT; NONSTEROID ANTIINFLAMMATORY AGENT; PROTON PUMP INHIBITOR; PSYCHOTROPIC AGENT; SEROTONIN UPTAKE INHIBITOR;

COST CONTROL; DRUG COST; DRUG FORMULARY; DRUG UTILIZATION; ECONOMIC EVALUATION; FUNDING; HEALTH CARE COST; HEALTH PROGRAM; MEDICAID; MEDICARE; PRESCRIPTION; PRIORITY JOURNAL; RESOURCE ALLOCATION; REVIEW;

COST-BENEFIT ANALYSIS; DRUG COSTS; DRUG UTILIZATION REVIEW; FORMULARIES; HUMANS; MEDICAID; PHARMACEUTICAL PREPARATIONS; PRESCRIPTIONS, DRUG; UNITED STATES;

EID: 41449091152     PISSN: 11707690     EISSN: None     Source Type: Journal    
DOI: 10.2165/00019053-200826040-00002     Document Type: Review

References (45)

1. OECD Health Data 2005 [online]. Available from URL: http://www.oecd.org [Accessed 2005 Nov]
2. National Center for Health Statistics. Health, United States [table 120]. Hyattsville (MD): NCHS, 2005: 361
3. Heffler S, Smith S, Keehan S, et al. US health spending projections for 2004-2014. Health Affairs, 2005 Feb [online]. Available from URL: http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.74/DC1
4. Rowland D. Medicaid: the basics [online]. Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation, 2005 Jun. Available from URL: http://www.KaiserEDU.org [Accessed 2005 Nov]
5. Suh DC, Lacy CR, Barone JA, et al. Factors contributing to trends in prescription drug expenditures. Clin Ther 1999 Jul; 21 (7): 1241-53
6. Gencarelli DM. Medicaid prescription drug coverage: state efforts to control costs [online]. National Health Policy Forum Issue Brief 2003 May 10; 790. Available from URL: http://www.nhpf.org/pdfs_ib/IB790_StateRx_5-10-03.pdf [Accessed 2007 Jul 10]
7. Smith V. The continuing medical budget challenge: state Medicaid spending growth and cost containment in fiscal year 2004 and 2005. Results from a 50-state survey. Washington, DC: Kaiser Commission on Medicaid and the Uninsured, 2004 Oct
8. Soumerai SB, Avorn J, Ross-Degnan D, et al. Payment restrictions for prescription drugs under Medicaid: effects on therapy, cost, and equity. N Engl J Med 1987; 317: 550-6
9. Jang R. Medicaid formularies: a critical review of the literature. J Pharm Mark Manage Spring 1988; 2 (3): 39-61
10. Soumerai SB, Ross-Degnan D, Fortess E, et al. A critical analysis of studies of state drug reimbursement policies: research in need of discipline. Milbank Quarterly 1993; 71 (2): 217-52
11. Lexchin J. Effects of restrictive formularies in the ambulatory care setting. Am J Manag Care 2001; 7: 69-76
12. Drummond MF, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of healthcare programmes. 3rd ed. Cary (NC): Oxford University Press, 2005
13. Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996; 313: 275-83
14. Siegel JE, Torrance GW, Russell LB, et al. Guidelines for pharmacoeconomic studies: recommendations from the panel on cost-effectiveness in health and medicine. Pharmacoeconomics 1997; 11: 159-68
15. Hjelmgren J, Berggren F, Andersson F. Health economic guidelines: similarities, differences and some implications. Value Health 2001; 4: 225-50
16. Hay J. Pharmacoeconomic guidelines: where do we go from here? Value Health 2001; 4 (3): 211
17. Hammel RW. Insights into public assistance medical care expenditures. JAMA 1972 Mar 27; 219 (1740): 39-61
18. Smith MC, Maclayton DW. The effect of closing a Medicaid formulary on the prescription of analgesic drugs. Hosp Formul 1977 Jan; 12: 36-77
19. Smith DM, McKercher PL. The elimination of selected drug products from the Michigan Medicaid formulary: a case study. Hosp Formul 1984; 19: 366-72
20. Bloom BS, Jacobs J. Cost effects of restricting cost-effective therapy. Med Care 1985; 23: 872-80
21. Schweitzer SO, Salehi H, Boling N. The social drug lag: an examination of pharmaceutical approval delays in Medicaid formularies. Soc Sci Med 1983; 21: 1077-82
22. Kreling DH, Knocke DJ, Hammel RW. Changes in market shares for internal analgesic products after a Medicaid formulary restriction. J Pharm Mark Manag 1988; 3 (2): 65-76
23. Dranove D. Medicaid drug formulary restrictions. J Law Econ 1989; 32: 143-62
24. Kreling DH, Knocke DJ, Hammel RW. The effects of an internal analgesic formulary restriction on Medicaid drug expenditures in Wisconsin. Med Care 1989; 27: 34-44
25. Kozma CM, Reeder CE, Lingle EW. Expanding Medicaid drug formulary coverage: effects on utilization of related services. Med Care 1990; 28: 963-77
26. Soumerai SB, Ross-Degnan D, Gortmaker S, et al. Withdrawing payment for non-scientific drug therapy: intended and unexpected effects of a large-scale natural experiment. J Am Med Assoc 1990; 263: 831-9
27. Kotzan JA, McMillan JA, Jankel CA, et al. Initial impact of a Medicaid prior authorization program for NSAID prescriptions. J Res Pharm Econ 1993; 5: 25-41
28. McCombs JS, Nichol MB. Pharmacy-enforced outpatient drug treatment protocols: a case study of Medi-Cal restrictions for cefaclor. Ann Pharmacother 1993; 27: 155-61
29. Moore WJ, Newman RJ. Drug formulary restrictions as a cost-containment policy in Medicaid programs. J Law Econ 1993; 36: 71-97
30. Soumerai SB, McLaughlin TJ, Ross-Degnan D, et al. Effects of a limit on Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. N Engl J Med 1994; 331 (10): 650-5
31. Smalley WE, Griffin MR, Fought RL, et al. Effect of a prior authorization requirement on the use of non-steroidal anti-inflammatory drugs by Medicaid patients. N Engl J Med 1995; 332: 1612-7
32. Martin BC, McMillan JA. The impact of implementing a more restrictive prescription limit on Medicaid recipients: effects on cost, therapy, and out-of-pocket expenditures. Med Care 1996 Jul; 34 (7): 686-701
33. Zechnich AD, Greenlick M, Haxby D. Elimination of over-the-counter medication coverage in the Oregon Medicaid population: the impact on program costs and drug use. Med Care 1998; 36: 1283-94
34. Cromwell DM, Bass EB, Steinberg EP, et al. Can restrictions on reimbursement for anti-ulcer drugs decrease Medicaid pharmacy costs without increasing hospitalizations? Health Serv Res 1999; 33: 1593-610
35. McCombs JS, Shi L, Croghan TW, et al. Access to drug therapy and substitution between alternative antidepressants following an expansion of the California Medicaid formulary. Health Policy 2003; 65: 301-11
36. Fischer MA, Schneeweiss S, Avorn J, et al. Medicaid prior-authorization programs and the use of cyclooxygenase-2 inhibitors. N Engl J Med 2004 Nov 18; 351 (21): 2187-94
37. McCombs JS, Mulani P, Gibson PJ. Open access to innovative drugs: treatment substitutions or treatment expansion? Health Care Financ Rev 2004 Spring; 25 (3): 35-53
38. Delate T, Mager DE, Sheth J, et al. Clinical and financial outcomes associated with a proton pump inhibitor prior-authorization program in a Medicaid population. Am J Manag Care 2005; 11: 29-36
39. Murawski MM, Abdelgawad T. Exploration of the impact of preferred drug lists on hospital and physician visits and the costs to Medicaid. Am J Manag Care 2005; 11: SP35-42
40. Meissner B, Dickson M, Shinogle J, et al. Drug and medical cost effects of a drug formulary change with therapeutic interchange for statin drugs in a multistate managed medicaid organization. J Manag Care Pharmacy 2006; 12 (4): 331-40
41. Milne J. Evaluation of pharmacoeconomic literature. Pharmacoeconomics 1994; 6 (4): 337-45
42. Trueman P, Drummond M, Hutton J. Developing guidance for budget impact analysis. Pharmacoeconomics 2001; 19 (6): 609-21
43. Johanesson M. A note on the depreciation of societal perspective in economic evaluation of health care. Health Policy 1995; 33: 59-66
44. Byford S, Palmer S. Common errors and controversies in pharmacoeconomic analyses. Pharmacoeconomics 1998 Jun; 13 (6): 659-66
45. Perloff JM. Microeconomics. 3rd ed. Reading (MA): Addison-Wesley, 2004 Jun