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A 54% response rate was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

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In an effort to contain costs while assuring quality, the Louisiana Medicaid program expanded its existing Lock‐in program (for high utilizers) in the summer and fall of 1995. Lock‐in recipients may be locked‐in to a primary care physician, a specialist, and/or a pharmacy. OBJECTIVE: The purpose of this research was to determine the impact of the lock‐in on pharmacy provider consistency, and the utilization of prescription drugs and expenditures for prescription drugs. METHODS: To be included in this study, a recipient must have been continuously eligible for Medicaid during the study period, not have been a nursing home patient, not participated in the Community Care program (a gate‐keeping program), and enrolled in the lock‐in program. Two years of pharmacy claims data were used in the analysis. A t‐test compared pharmacy provider consistency prior to and during the lock‐in. Segmented regression was used to determine if there were significant differences in the slopes and the levels of pre‐lock‐in and post‐lock‐in trend lines for utilization and expenditure variables. RESULTS: A total of 1,490 recipients met the inclusion criteria. The study group was predominantly female and white with an average age of 47.56. Results demonstrated that post lock‐in, recipients received significantly more prescriptions from a single pharmacy when compared to the pre‐lock period. Significant reductions were also found in the utilization of number of different drugs (a surrogate for polypharmacy), utilization of Schedule II narcotics, and total pharmacy costs (adjusted for decline in per unit cost). There was also a slight reduction in number of maintenance medications, but the difference was not significant. CONCLUSION: The lock‐in improved continuity of pharmacy care of enrolled Medicaid recipients. It also significantly decreased polypharmacy while having little effect on maintenance medications.

To reduce the number of drugs prescribed and polypharmacy among geriatric Medicaid recipients, Louisiana's ICFs I should minimize the number of physicians and pharmacies used in this population.