The Impact of Implementing a More Restrictive Prescription Limit on Medicaid Recipients

Abstract

On November 1, 1991, the Georgia Department of Medical Assistance reduced the maximum number of monthly reimbursable prescriptions from six to five. This policy change provided a natural experiment to investigate the recipient responses to a decrease in an existing prescription limit. The research design was a quasiexperimental, retrospective, 12-month interrupted time-series analysis of a cohort. The cohort consisted of 743 ambulatory recipients who were high prescription users. Complete Medicaid claims data were obtained, in addition to pharmacy-generated computer profiles for all cohort recipients to determine Medicaid and out-of-pocket prescriptions expenditures. Interrupted time-series analyses were performed to model the effect of the five-prescription limit on total, Medicaid-reimbursed, out-of-pocket, and prescription use across eight therapeutic categories. After the implementation of the five-prescription limit, total prescription use fell 6.6%, prescriptions reimbursed by Medicaid fell 9.9%, and prescriptions paid for out-of-pocket increased 9.7%. Abrupt, permanent decreases were observed for cardiovascular, miscellaneous, pulmonary, and palliative therapeutic drug categories (alpha = 0.05), whereas gastrointestinal, chemotherapy, hormone (insulin), and central nervous system prescription use remained constant. The implementation of a more restrictive prescription limit alters prescription regimens potentially predisposing elderly Medicaid recipients to clinical consequences. Further examination of the health outcomes of these recipients is necessary.

Inadequate Prescription-Drug Coverage for Medicare Enrollees — A Call to Action

“…5 In 1991, a less severe reduction in coverage in the Georgia Medicaid program (from six prescriptions to five per month) had similar results. 25 Restricted coverage for needed drugs may be a false economy. A follow-up study in New Hampshire found that chronically ill elderly persons affected by limits on Medicaid drug payments were twice as likely as members of a control cohort to enter nursing homes, where they remained permanently in most cases.…”

Special Needs Prescriptions at the Johns Hopkins Hospital. A Management Study..

“…These findings must be considered in developing new costs containment strategies at Hopkins, as approximately 65% of the SNP recipients were on some form of antihypertensive therapy. Findings by Martin and McMillan (1996) also support the opinion that reduced access to subsidized prescriptions may result in negative effects on patients' health. They found that restricting access to prescription medications resulted in abrupt, permanent decreases in the use of cardiovascular and pulmonary drugs which are critical to health maintenance of patients with such diseases (Martin and McMillan, 1996).…”

“…Findings by Martin and McMillan (1996) also support the opinion that reduced access to subsidized prescriptions may result in negative effects on patients' health. They found that restricting access to prescription medications resulted in abrupt, permanent decreases in the use of cardiovascular and pulmonary drugs which are critical to health maintenance of patients with such diseases (Martin and McMillan, 1996). Unlike McCombs however, Martin and McMillan did not extend their research to clinical health outcomes, but recommended such research be conducted.…”

Controlling Health Care Spending in Massachusetts: An Analysis of Options

“…683 Studies using longitudinal data found that, after controlling for state-specific factors, the relationship between Medicaid reimbursement and health care access was either attenuated 684 or eliminated . 685 Studies that have considered the relationship between Medicaid reimbursement and health care quality have focused primarily on nursing homes 686,687,688 or pharmaceuticals, 689,690,691 with fewer studies focusing on other aspects of the health care system . Finally, studies that have tested the cost-shifting hypothesis have focused primarily on California data 692,693,694 and have found small and sometimes statistically insignificant results regarding Medicaid cost-shifting .…”

“…700 As a result, increased Medicaid reimbursement would likely redistribute costs from private payers to state and federal governments . There is also evidence that higher Medicaid reimbursement rates may crowd-out charity care for the uninsured; 701 however, this effect may not be relevant in view of Massachusetts' health insurance mandate .…”