US Medicaid drug lists cost more, deliver less
The U.S. Medicaid program is likely paying far more than necessary for medications and not offering patients the most effective ones available, by ignoring international evidence-based lists of safe and effective medications, according to a new study by researchers at University of California, San Francisco.
The study, which compared the Medicaid program's Preferred Drug Lists in 40 states nationwide against the World Health Organization's 2009 Essential Medicines List, found that the medications that are automatically paid for by the state-run Medicaid programs vary widely from state to state, with few consistent protocols or rationales for their selection, including cost, safety or effectiveness of the medication.
The WHO essential medicines concept is designed to help countries allocate limited resources to the most-needed, safest and most effective medications. The list has been updated biannually since 2002, using rigorous international standards to weigh medications' safety and proven effectiveness, according to the researchers.
In 2007, the United Nations' health organization found that 131 countries out of 151 surveyed use the WHO Essential Medicines List as a basis for their national formulary, but the United States is not among them.
"The United States has 51 different lists of medications that are paid for by Medicaid, and only a third of those medications consistently appear on the various lists," said Lisa A. Bero, PhD, a professor in the UCSF School of Pharmacy. "This research suggests that Medicaid could save significant money and also provide safer and more effective medications for patients by using a more consistent approach to deciding which drugs will be covered."
The Medicaid program currently serves 60 million low-income U.S. citizens, or about 20 percent of the population, according to the paper. It is jointly funded by the federal and state governments and is managed by the states. Each state develops its own Preferred Drug List for its fee-for-service Medicaid patients, which identifies medicines that are fully reimbursed by Medicaid without prior authorization. Prescription drug benefits are the second largest spending category for the Medicaid program.
The study set out to determine whether Medicaid patients have access to all medications listed by the WHO as essential medicines, assess how closely the state lists follow the WHO recommendations and evaluate the consistency of state lists nationwide.
At the time of the study in late 2009, only lists from 40 states and the District of Columbia could be analyzed. Nine others were not available online and Tennessee had no fee-for-service plan for its patients. Managed-care Medicaid plans follow the managed care organization's drug formulary and are not publicly available.
The group identified 369 medicines in the nine therapeutic classes that had the highest annual Medicaid reimbursements and also were addressed by the WHO list. Those include medications for asthma, depression, diabetes and hypertension, among others.
All but six of the 120 WHO medications in those categories also appeared on most of the states' lists, but their use was inconsistent across the lists. The study found that an additional 249 medicines only appeared on state lists and were not considered as the most effective and safest medications by the WHO.
"The issue is not that our patients cannot get the WHO-recommended medications, but that they are receiving a wide variety of other medications that cost more and are not always as effective or safe," Bero said. "This study suggests that if states used the World Health Organization Essential Medicines List as a starting point, it might reduce the number of medicines available to Medicaid patients, but patients could have more confidence that the medicines they receive are effective and safe."
The 249 medications that only appeared on state lists were composed entirely of drugs that are either nongenerics, not the recommended therapy for a disease or combination therapies. They also were less likely than the WHO counterparts to have generic versions available: only 56 percent of the state-list medications have generics available, versus 76 percent of the WHO list. While each state negotiates its drug prices, the authors noted that generic drugs tend to be less costly, suggesting that states are paying more than they need to for effective medicines.
Bero said the high degree of variation among the state lists, lack of documented protocols, and the limited connection between a drug's proven clinical effectiveness and its appearance on these lists also suggests that state committees charged with developing these formularies do not have a consistent methodology for listing medications.
Provided by University of California, San Francisco
- Medicaid policies vary widely for rheumatoid arthritis drugs Nov 04, 2008 | not rated yet | 0
- Some drugs increase risk of falling Jul 09, 2008 | not rated yet | 0
- Restrictive drug policies often cause schizophrenic patients to discontinue medication Apr 01, 2008 | not rated yet | 0
- Innappropriate drug prescriptions wasting millions, raising health risks Mar 04, 2009 | not rated yet | 0
- States look at ways to ease Medicaid cuts Jun 29, 2007 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Why is zone 1 in liver more prone to ischemic injury?
May 23, 2013 Hi, Is it because around central vein, there is only deoxygenated blood from the vein where as in the periphery there is hepatic artery. Also why...
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013 As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
- More from Physics Forums - Medical Sciences
More news stories
(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...
Medications 1 hour ago | not rated yet | 0
(AP)—Merck & Co. says it is ending development of an experimental Parkinson's disease drug because the drug wasn't working.
Medications May 23, 2013 | 1 / 5 (1) | 0
(AP)—Johnson & Johnson is developing what could eventually be game-changing treatments for depression and pain, and it's aiming to apply for approval of more than 10 new medicines by 2017, executives said Thursday during ...
Medications May 23, 2013 | 5 / 5 (1) | 0
An independent panel of experts on Wednesday recommended US approval of a new Merck sleeping pill called suvorexant, but expressed concerns over the highest dosage and risks of drowsy daytime driving.
Medications May 22, 2013 | not rated yet | 0
Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...
1 hour ago | not rated yet | 1
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...
1 hour ago | not rated yet | 2
Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...
1 hour ago | not rated yet | 0
(Medical Xpress)—A new study by researchers in the US has shown that an ancient virus can be modified to help in the fight against the simian immunodeficiency virus SIV, which is the equivalent in monkeys ...
23 hours ago | 5 / 5 (3) | 0 |
Two mutations central to the development of infantile myofibromatosis (IM)—a disorder characterized by multiple tumors involving the skin, bone, and soft tissue—may provide new therapeutic targets, according to researchers ...
17 hours ago | 3 / 5 (2) | 0 |
Ernie Pyle – an iconic war correspondent in World War II – reportedly said "There are no atheists in foxholes." A new joint study between two brothers at Cornell and Virginia Wesleyan found that only ...
22 hours ago | 2.5 / 5 (4) | 2