The role of clinical and cost information in Medicaid pharmacy benefit decisions: experience in seven states
- Collection:
- Health Policy and Services Research
- Author(s):
- Gaffney, Jenny, author Kress, Marielle, author Pearson, Caroline, author Carino, Tanisha, author Connolly, John, author Rudowitz, Robin, author
- Contributor(s):
- Henry J. Kaiser Family Foundation, issuing body. Kaiser Commission on Medicaid and the Uninsured, issuing body.
- Publication:
- Washington, DC : Henry J. Kaiser Family Foundation, September 2011
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Economics, Pharmaceutical Insurance, Pharmaceutical Services Medicaid -- economics Pharmaceutical Preparations -- economics State Health Plans -- economics United States
- Genre(s):
- Technical Report
- Abstract:
- Now more than ever, Medicaid programs face a delicate balance in providing health care access to vulnerable individuals and being prudent with taxpayer dollars. Looking forward to fiscal year 2012, 44 states and the District of Columbia are projecting budget shortfalls totaling $112 billion. This comes at the same time as Medicaid enrollment is increasing due to a sluggish economy. Over the years, states have proactively employed a variety of strategies in their Medicaid fee-for-service programs to maximize beneficiary access to beneficial prescription drugs while striving to minimize costs. The majority of states use preferred drug lists (PDLs), which generally list "preferred" medications that are found to be the least costly, therapeutically-appropriate drugs that Medicaid beneficiaries may receive without first obtaining prior authorization (PA) from the state. States have also invested internal and external resources to augment the capacity for using clinical and cost evidence to inform pharmacy policies. Recently the federal government, through the American Recovery and Reinvestment Act (ARRA) and the Affordable Care Act (ACA), has provided significant funding for research to help Medicaid programs and others identify what treatments work best for specific patient populations. The goal of this research is to evaluate how Medicaid programs are applying clinical evidence in their pharmaceutical policies. To answer this question, Avalere Health and the Kaiser Family Foundation Commission on Medicaid and the Uninsured conducted primary and secondary research from January to July 2011 on seven state Medicaid programs--Florida, Louisiana, Maryland, Massachusetts, Minnesota, Nevada, and Washington--and three Medicaid managed care plans--Amerigroup, Molina Healthcare, and United--operating in these markets. Our goal was to determine how states evaluate relative clinical and cost information about prescription drugs when making coverage decisions for Medicaid pharmacy benefits.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (23 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101572369 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101572369