The impact of implementing a more restrictive prescription limit on Medicaid recipients. Effects on cost, therapy, and out-of-pocket expenditures.
The impact of implementing a more restrictive prescription limit on Medicaid recipients. Effects on cost, therapy, and out-of-pocket expenditures.
复制标题
对医疗补助受益人实施更严格的处方限制的影响。
作者：
Bradley C. Martin;J. A. McMillan
1991年11月1日，格鲁吉亚医疗援助部将每月可报销处方的最高数量从6个减少到5个。这一政策变化提供了一个自然的实验，以调查收件人的反应，减少现有的处方限制。研究设计是一个准实验性的，回顾性的，12个月的中断时间序列分析的队列。该队列由743名门诊接受者组成，他们是高处方用户。除了获得所有队列接受者的药房生成的计算机配置文件外，还获得了完整的医疗补助索赔数据，以确定医疗补助和自付处方支出。进行中断时间序列分析，以模拟五种处方限制对八种治疗类别的总使用、医疗补助报销、自付和处方使用的影响。实施五种处方限制后，处方使用总量下降了6.6%，医疗补助报销的处方下降了9.9%，自付处方增加了9.7%。观察到心血管、杂项、肺部和姑息治疗药物类别（α = 0.05）的突然、永久性减少，而胃肠道、化疗、激素（胰岛素）和中枢神经系统处方使用保持不变。实施更严格的处方限制改变了处方方案，可能使老年医疗补助接受者倾向于临床后果。有必要进一步检查这些接受者的健康结果。
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.