Benefits and risks of increasing restrictions on access to costly drugs in medicaid

Health Affairs

Volumn 23, Issue 1, 2004, Pages 135-146

  Soumerai, Stephen B ^a  

^a HARVARD MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIDEPRESSANT AGENT; ANTIHYPERTENSIVE AGENT; BARBITURIC ACID DERIVATIVE; BENZODIAZEPINE DERIVATIVE; BRONCHODILATING AGENT; CYCLOOXYGENASE 2 INHIBITOR; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; HISTAMINE H2 RECEPTOR ANTAGONIST; IBUPROFEN; NONSTEROID ANTIINFLAMMATORY AGENT; SEDATIVE AGENT; SEROTONIN UPTAKE INHIBITOR;

ARTHRITIS; COST BENEFIT ANALYSIS; COST CONTROL; COST EFFECTIVENESS ANALYSIS; DATA BASE; DRUG APPROVAL; DRUG COST; DRUG MANUFACTURE; DRUG MARKETING; DRUG USE; HEALTH CARE ACCESS; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH SERVICE; HUMAN; HYPERTENSION; INFLAMMATION; MEDICAID; MEDICARE; MEDLINE; PAIN; PRESCRIPTION; REIMBURSEMENT; REVIEW; RISK BENEFIT ANALYSIS;

COST SHARING; DRUG COSTS; HEALTH SERVICES ACCESSIBILITY; INSURANCE COVERAGE; INSURANCE, PHARMACEUTICAL SERVICES; MEDICAID; RISK ASSESSMENT; STATE GOVERNMENT;

EID: 4344699183     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.23.1.135     Document Type: Review

References (76)

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3. U.S. General Accounting Office, Prescription Drugs: FDA Oversight of Direct-to-Consumer Advertising Has Limitations, Pub. no. GAO-03-177 (Washington: GAO, October 2002).
4. Centers for Medicare and Medicaid Services, "CMS Benefit Payments by Major Personal Health Expenditure Service Categories, Calendar Year 2000," in 2002 Data Compendium, September 2002, cms.hhs.gov/ researchers/pubs/ datacompendium/2002/02pg13.pdf (16 October 2003). On the cost-effectiveness of medications, see Scandinavian Simvastatin Survival Study Group, "Randomised Trial of Cholesterol Lowering in 4,444 Patients with Coronary Heart Disease: The Scandinavian Simvastatin Survival Study," Lancet 344, no. 8934 (1994): 1383-1389; and S.B. Soumerai et al., "Adverse Outcomes of Underuse of Beta-Blockers in Elderly Survivors of Acute Myocardial Infarction," Journal of the American Medical Association 277, no. 2 (1997): 115-121.
5. Centers for Medicare and Medicaid Services, "CMS Benefit Payments by Major Personal Health Expenditure Service Categories, Calendar Year 2000," in 2002 Data Compendium, September 2002, cms.hhs.gov/ researchers/pubs/ datacompendium/2002/02pg13.pdf (16 October 2003). On the cost-effectiveness of medications, see Scandinavian Simvastatin Survival Study Group, "Randomised Trial of Cholesterol Lowering in 4,444 Patients with Coronary Heart Disease: The Scandinavian Simvastatin Survival Study," Lancet 344, no. 8934 (1994): 1383-1389; and S.B. Soumerai et al., "Adverse Outcomes of Underuse of Beta-Blockers in Elderly Survivors of Acute Myocardial Infarction," Journal of the American Medical Association 277, no. 2 (1997): 115-121.
6. Centers for Medicare and Medicaid Services, "CMS Benefit Payments by Major Personal Health Expenditure Service Categories, Calendar Year 2000," in 2002 Data Compendium, September 2002, cms.hhs.gov/ researchers/pubs/ datacompendium/2002/02pg13.pdf (16 October 2003). On the cost-effectiveness of medications, see Scandinavian Simvastatin Survival Study Group, "Randomised Trial of Cholesterol Lowering in 4,444 Patients with Coronary Heart Disease: The Scandinavian Simvastatin Survival Study," Lancet 344, no. 8934 (1994): 1383-1389; and S.B. Soumerai et al., "Adverse Outcomes of Underuse of Beta-Blockers in Elderly Survivors of Acute Myocardial Infarction," Journal of the American Medical Association 277, no. 2 (1997): 115-121.
7. National Conference of State Legislatures, "Recent Medicaid Prescription Drug Laws and Strategies, 2001-2003," 9 October 2003, www.ncsl.org/programs/health/medicaidrx.htm (11 November 2003); and Kaiser Commission, "Medicaid: Purchasing Prescription Drugs."
8. National Conference of State Legislatures, "Recent Medicaid Prescription Drug Laws and Strategies, 2001-2003," 9 October 2003, www.ncsl.org/programs/health/medicaidrx.htm (11 November 2003); and Kaiser Commission, "Medicaid: Purchasing Prescription Drugs."
9. B. Bruen, "Medicaid and Prescription Drugs: An Overview," October 2000, www.kff.org/content/2000/ 2202/mcaidandrx.pdf (16 October 2003); and B. Bruen and J. Holahan, "Medicaid Spending Growth Remained Modest in 1998, but Likely Headed Upward," Issue Paper, Pub. no. 2230, February 2001, www.kff. org/content/2001/2230/2230.pdf (16 October 2003).
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11. S.B. 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; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; S.B. 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 331, no. 10 (1994): 650-655; and R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429.
12. S.B. 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; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; S.B. 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 331, no. 10 (1994): 650-655; and R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429.
13. S.B. 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; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; S.B. 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 331, no. 10 (1994): 650-655; and R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429.
14. S.B. 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; S.B. Soumerai et al., "Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes," New England Journal of Medicine 325, no. 15 (1991): 1072-1077; S.B. 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 331, no. 10 (1994): 650-655; and R. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing among Poor and Elderly Persons," Journal of the American Medical Association 285, no. 4 (2001): 421-429.
15. Soumerai et al., "Payment Restrictions for Prescription Drugs"; Soumerai et al., "Effects of Medicaid Drug-Payment Limits"; Soumerai et al., "Effects of Limiting Medicaid Drug-Reimbursement Benefits"; and E.E. Fortess et al., "Utilization of Essential Medications by Vulnerable Elderly after a Drug Benefit Cap: Importance of Mental Disorders, Chronic Pain, and Practice Setting," Journal of the American Geriatrics Society 49, no. 6 (2001): 793-797.
16. Soumerai et al., "Payment Restrictions for Prescription Drugs"; Soumerai et al., "Effects of Medicaid Drug-Payment Limits"; Soumerai et al., "Effects of Limiting Medicaid Drug-Reimbursement Benefits"; and E.E. Fortess et al., "Utilization of Essential Medications by Vulnerable Elderly after a Drug Benefit Cap: Importance of Mental Disorders, Chronic Pain, and Practice Setting," Journal of the American Geriatrics Society 49, no. 6 (2001): 793-797.
17. Soumerai et al., "Payment Restrictions for Prescription Drugs"; Soumerai et al., "Effects of Medicaid Drug-Payment Limits"; Soumerai et al., "Effects of Limiting Medicaid Drug-Reimbursement Benefits"; and E.E. Fortess et al., "Utilization of Essential Medications by Vulnerable Elderly after a Drug Benefit Cap: Importance of Mental Disorders, Chronic Pain, and Practice Setting," Journal of the American Geriatrics Society 49, no. 6 (2001): 793-797.
18. Soumerai et al., "Payment Restrictions for Prescription Drugs"; Soumerai et al., "Effects of Medicaid Drug-Payment Limits"; Soumerai et al., "Effects of Limiting Medicaid Drug-Reimbursement Benefits"; and E.E. Fortess et al., "Utilization of Essential Medications by Vulnerable Elderly after a Drug Benefit Cap: Importance of Mental Disorders, Chronic Pain, and Practice Setting," Journal of the American Geriatrics Society 49, no. 6 (2001): 793-797.
19. Soumerai et al., "Effects of Limiting Medicaid Drug-Reimbursement Benefits."
20. Tamblyn et al., "Adverse Events Associated with Prescription Drug Cost-Sharing."
21. See S.B. Soumerai et al., "A Critical Analysis of Studies of State Drug Reimbursement Policies: Research in Need of Discipline," Milbank Quarterly 71, no. 2 (1993): 217-52.
22. I b i d.
23. Ibid.; and J. Santa, "Oregon's Approach to Prescription Drugs," slide presentation at Web-assisted audio-conference, "Causes of and Potential Solutions to the High Cost of Health Care," 15 October 2002, Agency for Healthcare Research and Quality, www.ahrq.gov/news/ulp/hicosttele/ sess3/santatxt.htm (28 August 2003).
24. Ibid.; and J. Santa, "Oregon's Approach to Prescription Drugs," slide presentation at Web-assisted audio-conference, "Causes of and Potential Solutions to the High Cost of Health Care," 15 October 2002, Agency for Healthcare Research and Quality, www.ahrq.gov/news/ulp/hicosttele/ sess3/santatxt.htm (28 August 2003).
25. Soumerai et al., "A Critical Analysis of Studies."
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27. NCSL, "Recent Medicaid Prescription Drug Laws and Strategies, 2001-2003."
28. I b i d.
29. R. Pérez-Peña, "Twenty-two States Limiting Doctors' Latitude in Medicaid Drugs," New York Times, 16 June 2003.
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33. NCSL, "Recent Medicaid Prescription Drug Laws and Strategies, 2001-2003."
34. B.S. Bloom and J. Jacobs, "Cost Effects of Restricting Cost-Effective Therapy," Medical Care 23, no. 7 (1985): 872-880; and Soumerai et al., "A Critical Analysis of Studies."
35. B.S. Bloom and J. Jacobs, "Cost Effects of Restricting Cost-Effective Therapy," Medical Care 23, no. 7 (1985): 872-880; and Soumerai et al., "A Critical Analysis of Studies."
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38. Fineberg et al., "Surgical Treatment of Peptic Ulcer;" and Soumerai et al., "A Critical Analysis of Studies."
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40. W.E. Smalley et al., "Effect of a Prior Authorization Requirement on the Use of Nonsteroidal Anti-inflammatory Drugs by Medicaid Patients," New England Journal of Medicine 332, no. 24 (1995): 1612-1617.
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42. J.A. Kotzan et al., "Initial Impact of a Medicaid Maintenance Dose Program for H2 Antagonist Prescriptions," Journal of Research in Pharmaceutical Economics 5, no. 1 (1993): 43-58; and J.A. Kotzan et al., "Initial Impact of a Medicaid Prior Authorization Program for NSAID Prescriptions," Journal of Research in Pharmaceutical Economics 5, no. 1 (1993): 25-41.
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56. Bloom and Jacobs, "Cost Effects of Restricting Cost-Effective Therapy."
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59. Smalley et al., "Effect of a Prior Authorization Requirement"; Kotzan et al., "Initial Impact of a Medicaid Maintenance Dose Program"; and Kotzan et al., "Initial Impact of a Medicaid Prior Authorization Program."
60. Soumerai et al., "Withdrawing Payment."
61. Schneeweiss et al., "Impact of Reference-Based Pricing"; Schneeweiss et al., "Outcomes of Reference Drug Pricing"; Grootendorst, "Impact of Reference-Based Pricing of Nitrates"; and Hazlet et al., "Health Services Utilization."
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63. Schneeweiss et al., "Impact of Reference-Based Pricing"; Schneeweiss et al., "Outcomes of Reference Drug Pricing"; Grootendorst, "Impact of Reference-Based Pricing of Nitrates"; and Hazlet et al., "Health Services Utilization."
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65. Schneeweiss et al., "Outcomes of Reference Drug Pricing"; and Hazlet et al., "Health Services Utilization."
66. Schneeweiss et al., "Outcomes of Reference Drug Pricing"; and Hazlet et al., "Health Services Utilization."
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71. Soumerai et al., "Effects of Limiting Medicaid Drug-Reimbursement Benefits."
72. Smalley et al., "Effect of a Prior Authorization Requirement"; and Schneeweiss et al., "Outcomes of Reference Drug Pricing."
73. Smalley et al., "Effect of a Prior Authorization Requirement"; and Schneeweiss et al., "Outcomes of Reference Drug Pricing."
74. Bloom and Jacobs, "Cost Effects of Restricting Cost-Effective Therapy."
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76. Soumerai et al., "A Critical Analysis of Studies."