The impact of implementing a more restrictive prescription limit on Medicaid recipients. Effects on cost, therapy, and out-of-pocket expenditures

Med Care. 1996 Jul;34(7):686-701. doi: 10.1097/00005650-199607000-00003.

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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chronic Disease / drug therapy*
  • Cohort Studies
  • Drug Costs
  • Drug Prescriptions / statistics & numerical data*
  • Drug Utilization Review / economics
  • Drug Utilization Review / statistics & numerical data
  • Female
  • Financing, Personal / statistics & numerical data
  • Georgia
  • Humans
  • Insurance, Pharmaceutical Services / legislation & jurisprudence*
  • Insurance, Pharmaceutical Services / statistics & numerical data
  • Male
  • Medicaid / legislation & jurisprudence*
  • Medicaid / statistics & numerical data
  • Middle Aged
  • Retrospective Studies
  • Seasons
  • State Health Plans / legislation & jurisprudence
  • Time Factors
  • United States