Administration of epinephrine and glucose, as well as drugs that influence cholinergic and opiate systems, can enhance or impair memory. The present experiments examined the possibility that peripheral glucose administration might reverse scopolamine- and morphine-induced impairments in a spontaneous alternation task. Mice received all drug administrations 30 min before testing. Scopolamine-induced (3 mg/kg) deficits in alternation performance were reversed by glucose (100 and 250 mg/kg), amphetamine (1 mg/kg), epinephrine, physostigmine, and oxotremorine (each 0.1 mg/kg). Morphine (10 mg/kg) also impaired spontaneous alternation performance, and glucose (100 and 300 mg/kg) reversed this impairment as well. These findings are consistent with the view that central cholinergic systems, possibly under inhibitory opiate regulation, may contribute to glucose and epinephrine effects on memory storage.

P a t i e n t c o s t s h a r i n g h a sb e e n a d o m i n a n t cost-containment strategy in Medicaid since its inception. During the 1980s, coincident with large increases in the cost of the state pharmaceutical benefit programs, many Medicaid programs raised pharmaceutical copayments or introduced prescription reimbursement limits (e.g., three prescriptions per recipient per month), sometimes with adverse clinical and economic consequences. However, despite the major economic and health impact of these cost-containment policies, there is little information on how state policy makers select and evaluate them. We surveyed key informants in 48 Medicaid programs to investigate the factors influencing recent changes in drug cost-sharing policies; their expected positive and negative outcomes; internal and external factors constraining policy choices; whether, and how, the effects of the policy were evaluated; and the role of objective research data in influencing policy decisions. In organizing our analysis, we differentiated between state policy infrastructures that predisposed key actors to make certain kinds of decisions and the external political and economic forces that often precipitated policy changes.

Before 1990 many state Medicaid programs maintained "restrictive" formularies, which denied reimbursement for unlisted prescription drugs. This type of formulary has been criticized for denying important medications to poor, medically needy persons. As part of the Omnibus Budget Reconciliation Act of 1990, restrictive formularies in Medicaid programs were disallowed. Based on research into the 200 top-selling prescription drugs in the United States, we conclude that eliminating Medicaid restrictive formularies improved access to a subset of the 200 best sellers, but that the majority of these products offered only questionable or no additional therapeutic benefit.

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From the US payer's perspective, the combined genetic and clinical risk assessment strategy may be a moderately cost-effective alternative to using clinical risk alone to guide chemoprevention recommendations for women at intermediate risk of developing breast cancer.