Preferred drug lists and Medicaid prescriptions.
ABSTRACT When Medicaid preferred drug lists (PDLs) are implemented, they may impose indirect costs on prescribing physicians and Medicaid patients, leading to an unintended reduction in the number of Medicaid prescriptions filled.
To test retrospectively the proposition that PDLs adversely affect the number of Medicaid prescriptions filled.
We compared three 'test' states (Alabama, Texas, and Virginia) that implemented PDLs with restrictions on the prescription of statins with three 'control' states (New Jersey, North Carolina, and Pennsylvania) that did not implement drug access restrictions. We conducted the analysis at the county level and used a differences-in-differences approach that allows for county and time-period fixed effects.
We found that PDLs adversely impacted several measures of filled Medicaid prescriptions in the 'test' states relative to the 'control' states.
There are unintended but potentially harmful consequences to cost-focused health policy interventions.
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ABSTRACT: We used the Arizona Medicaid program as a model to examine the consequences of the relative restrictiveness of nonsteroidal anti-inflammatory drug (NSAID)-preferred drug lists on health care use and costs for Medicaid enrollees with arthritis. In a retrospective, cross-sectional study of Medicaid enrollees with rheumatoid arthritis or osteoarthritis, we used data from the Arizona HealthQuery database and generalized linear regression models to estimate the effect of the restrictiveness of formularies on the association between number of NSAID drugs covered and the number of emergency department visits, ambulatory physician visits, hospital stays, and total health expenditures. For plans with NSAID formularies that were more restrictive, enrollees with rheumatoid arthritis experienced 22% fewer ambulatory visits and 29% more hospitalizations, and enrollees with osteoarthritis experienced 38% fewer ambulatory visits and 52% more hospitalizations. These plans spent an additional $935 for medical care and prescription drugs annually per enrollee with rheumatoid arthritis. Formularies that are more restrictive significantly change the patterns of health care and prescription drug use and may have unintended consequences in terms of more frequent and, for those with rheumatoid arthritis, more expensive medical care.American Journal of Public Health 08/2008; 98(7):1300-5. DOI:10.2105/AJPH.2007.118133 · 4.23 Impact Factor
PharmacoEconomics 02/2006; 24 Suppl 3:1-3. DOI:10.2165/00019053-200624003-00001 · 3.34 Impact Factor
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ABSTRACT: The evolution of preferred drug lists (PDLs) as policy mechanisms for reducing state Medicaid program drug spending has occurred with little or no foundation in research. An emerging body of evidence suggests that indirect and programmatic costs limit the effectiveness of PDLs as a cost-saving mechanism. This article evaluates program-reported savings and the evidence for increased indirect costs, and finds little to support the long-term viability of this cost-containment strategy. In addition, evidence is reviewed that makes a strong case that PDLs create a disproportionate burden for minorities and the impoverished. PDLs will gradually become indistinguishable from formularies, and will eventually face legal challenge as a consequence.Expert Review of Pharmacoeconomics & Outcomes Research 02/2008; 8(1):65-71. DOI:10.1586/1473718.104.22.168 · 1.87 Impact Factor