Determinants of Change in Medicaid Pharmaceutical Cost Sharing: Does Evidence Affect Policy?

Abstract

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.

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