Preferred drug lists and Medicaid prescriptions.

Pfizer Inc, New York, NY 10017, USA.
PharmacoEconomics (Impact Factor: 2.45). 02/2006; 24 Suppl 3:55-63. DOI: 10.2165/00019053-200624003-00005
Source: PubMed


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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  • No preview · Article · Feb 2006 · PharmacoEconomics
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    ABSTRACT: Prescription drugs are instrumental to managing and preventing chronic disease. Recent changes in US prescription drug cost sharing could affect access to them. To synthesize published evidence on the associations among cost-sharing features of prescription drug benefits and use of prescription drugs, use of nonpharmaceutical services, and health outcomes. We searched PubMed for studies published in English between 1985 and 2006. Among 923 articles found in the search, we identified 132 articles examining the associations between prescription drug plan cost-containment measures, including co-payments, tiering, or coinsurance (n = 65), pharmacy benefit caps or monthly prescription limits (n = 11), formulary restrictions (n = 41), and reference pricing (n = 16), and salient outcomes, including pharmacy utilization and spending, medical care utilization and spending, and health outcomes. Increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy. For each 10% increase in cost sharing, prescription drug spending decreases by 2% to 6%, depending on class of drug and condition of the patient. The reduction in use associated with a benefit cap, which limits either the coverage amount or the number of covered prescriptions, is consistent with other cost-sharing features. For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia. While low-income groups may be more sensitive to increased cost sharing, there is little evidence to support this contention. Pharmacy benefit design represents an important public health tool for improving patient treatment and adherence. While increased cost sharing is highly correlated with reductions in pharmacy use, the long-term consequences of benefit changes on health are still uncertain.
    Full-text · Article · Aug 2007 · JAMA The Journal of the American Medical Association
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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.
    No preview · Article · Feb 2008 · Expert Review of Pharmacoeconomics & Outcomes Research
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