Buchanan R J, Smith S R
Department of Community Health, University of Illinois, Champaign 61820.
Ann Pharmacother. 1994 Apr;28(4):528-35. doi: 10.1177/106002809402800418.
To determine how Medicaid prescription drug policies differ by state, and to assess how these policies affect pharmacies and the drug therapies available to Medicaid patients with HIV infection or tuberculosis. EVALUATION PROCESS: The state affiliates of the American Pharmaceutical Association (APhA) were surveyed to learn how state Medicaid policies impact the provision of prescription drugs to Medicaid patients within their state. The survey focused on Medicaid payment level incentives, Medicaid payments compared with private payments, Medicaid utilization policies, and incentives and disincentives in each state's Medicaid payment system.
Approximately two-thirds of the APhA affiliates reported that the Medicaid payment levels in their states for drugs used to treat HIV-related illnesses were at least moderately below private payment levels; in 11 states these Medicaid payments were substantially below those of private payers. Many APhA affiliates responding to the survey stated that the Medicaid program in their state limited the number of reimbursed drugs that Medicaid patients can receive. Eight APhA affiliates reporting that these utilization limits created restrictions on the ability of Medicaid patients with AIDS and HIV-related infections to receive needed medications.
With Medicaid programs becoming the major payers of AIDS-related healthcare, federal policies should standardize Medicaid coverage, payment, and utilization policies for prescription drugs needed by Medicaid recipients with HIV-related conditions. This would enable Medicaid patients to receive necessary and adequate drug therapies regardless of their state of residence. These federally mandated policies also would require an increased federal role in financing this expanded Medicaid drug coverage.
确定各州医疗补助处方药政策有何不同，并评估这些政策如何影响药房以及可供感染艾滋病毒或患结核病的医疗补助患者使用的药物治疗。
对美国药学协会（APhA）的各州分支机构进行了调查，以了解各州医疗补助政策如何影响本州向医疗补助患者提供处方药的情况。该调查聚焦于医疗补助支付水平激励措施、与私人支付相比的医疗补助支付情况、医疗补助使用政策以及各州医疗补助支付系统中的激励和抑制因素。
约三分之二的APhA分支机构报告称，其所在州用于治疗艾滋病毒相关疾病的药物的医疗补助支付水平至少适度低于私人支付水平；在11个州，这些医疗补助支付大幅低于私人支付者的支付水平。许多回复调查的APhA分支机构表示，其所在州的医疗补助计划限制了医疗补助患者可获得报销的药物数量。8个APhA分支机构报告称，这些使用限制对患有艾滋病和艾滋病毒相关感染的医疗补助患者获得所需药物的能力造成了限制。
随着医疗补助计划成为艾滋病相关医疗保健的主要支付者，联邦政策应规范医疗补助对感染艾滋病毒相关疾病的医疗补助接受者所需处方药的覆盖范围、支付和使用政策。这将使医疗补助患者无论居住在哪个州都能获得必要和充足的药物治疗。这些联邦强制政策还将要求联邦在为这一扩大的医疗补助药物覆盖范围提供资金方面发挥更大作用。
