Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, USA.
Health Aff (Millwood). 2012 Apr;31(4):816-26. doi: 10.1377/hlthaff.2011.0246.
Michigan's Medicaid program implemented four cost containment policies--preferred drug lists, joint and multistate purchasing arrangements, and maximum allowable cost--during 2002-04. The goal was to control growth of drug spending for beneficiaries who were enrolled in both Medicaid and Medicare and taking antihypertensive or antihyperlipidemic prescription drugs. We analyzed the impact of each policy while holding the effect of all other policies constant. Preferred drug lists increased both preferred and generic drugs' market share and reduced daily cost--the cost per day for each prescription provided to a beneficiary. In contrast, the maximum allowable cost policy increased daily cost and was the only policy that did not generate cost savings. The joint and multistate arrangements did not affect daily cost. Despite these policy trade-offs, the cumulative effect was a 10 percent decrease in daily cost and a total cost savings of $46,195 per year. Our findings suggest that policy makers need to evaluate the impact of multiple policies aimed at restraining drug spending, and further evaluate the policy trade-offs, to ensure that scarce public dollars achieve the greatest return for money spent.
密歇根州的医疗补助计划在 2002-04 年期间实施了四项成本控制政策——首选药物清单、联合和州际采购安排以及最高允许成本——以控制同时参加医疗补助和医疗保险并服用抗高血压或抗高血脂处方药的受益人的药物支出增长。我们在保持所有其他政策的效果不变的情况下，分析了每项政策的影响。首选药物清单增加了首选药物和仿制药的市场份额，并降低了每日成本——即提供给受益人的每份处方的每日成本。相比之下，最高允许成本政策增加了每日成本，而且是唯一没有节省成本的政策。联合和州际安排并没有影响每日成本。尽管存在这些政策权衡，但累计效应是每日成本降低了 10%，每年总共节省了 46195 美元。我们的研究结果表明，政策制定者需要评估旨在控制药物支出的多项政策的影响，并进一步评估政策权衡，以确保稀缺的公共资金实现支出的最大回报。
