EFFECT OF MEDICAID DRUG COPAYMENTS ON OUTCOMES AND COSTS

处方药自付是否真的会导致医疗补助受益人更高的医疗服务利用率和成本？在过去的十年里，州医疗补助计划中的处方药支出的增长速度远远超过了通胀。建立处方药共同支付一直是各州实施的一项成本控制战略，研究表明，受益人分担费用导致处方药使用率下降。不太清楚的是，共同支付对其他“替代”医疗服务的利用的影响，如住院、门诊和内科服务以及长期护理。目前也不清楚各州是否真的在省钱，因为这些替代医疗服务的医疗补助额外成本可能会超过共同支付节省的药品成本。这项研究旨在回答以下问题：*药品共同支付对参加医疗补助的人的处方药使用有什么影响？*处方药共同支付与医疗补助受益人对其他医疗服务的利用之间有什么联系？*处方药共同支付是否与一个州的医疗补助计划的净成本节省有关？这项研究将使用来自医疗保健融资管理局(HCFA)的州医疗补助研究文件和医疗保险文件的两年行政数据来评估药物共同支付对患有充血性心力衰竭的密苏里州和明尼苏达州医疗补助受益人的影响。将使用多变量分析技术来分析药品和其他卫生服务利用和支出的变化。研究结果将帮助各州评估药品共同支付政策在其医疗补助计划中的成本和收益。

Do prescription drug copayments actually lead to higher health services utilization and costs for Medicaid beneficiaries? Prescription drug expenditures in state Medicaid programs have risen at rates far in excess of inflation during the past decade. Instituting copayments for prescription drugs has been a cost-containment strategy implemented by states, and studies suggest that beneficiary cost sharing has led to a decrease in prescription drug utilization. What is less clear is the effect of copayments on utilization of other "substitute" medical services, such as hospitalization, outpatient and physician services, and long-term care. It is also unclear if states are really saving money because the additional cost to Medicaid for these substitute medical services may exceed the drug cost savings from copayments. This study is designed to answer the following questions: * What is the impact of a drug copayment on prescription drug utilization for persons enrolled in Medicaid? * What is the association between a copayment for prescription drugs and the utilization of other medical services by Medicaid beneficiaries? * Are prescription drug copayments related to a net cost savings for a state's Medicaid program? This study will use two years of administrative data from the Health Care Financing Administration'S (HCFA's) State Medicaid Research Files and Medicare Files to evaluate the impact of drug copayments on Missouri and Minnesota Medicaid beneficiaries with congestive heart failure. Multivariate analytic techniques will be used to analyze the variation in drug and other health services utilization and expenditures. The study findings will help states assess the costs and benefits of a drug copayment policy in their Medicaid programs.