Soumerai S B, Ross-Degnan D, Fortess E E, Abelson J
Harvard Medical School.
Milbank Q. 1993;71(2):217-52.
Concerns over pharmaceutical costs and appropriateness of medication use have led state Medicaid programs to restrict drug reimbursement. This article critically reviews 20 years of research on cost sharing, drug reimbursement limits, and administrative limitations on access to particular drugs via formularies, category exclusions, or prior authorization requirements; evaluates their methodological rigor; summarizes the state of current knowledge; and proposes future research directions. Drug reimbursement caps and modest cost sharing can reduce the use of both essential and less important drugs in Medicaid populations; severe reimbursement caps may precipitate serious unintended effects. Limitations on access to particular drugs can cause both rational and irrational drug substitution effects; it is unclear whether such limits reduce expenditures either for drugs or for overall health care.
对药品成本和用药合理性的担忧导致各州医疗补助计划限制药品报销。本文批判性地回顾了20年来关于费用分担、药品报销限额以及通过药品目录、类别排除或事先授权要求对获取特定药品进行行政限制的研究；评估了这些研究方法的严谨性；总结了当前的知识状况；并提出了未来的研究方向。药品报销上限和适度的费用分担会减少医疗补助人群中基本药物和非基本药物的使用；严格的报销上限可能会引发严重的意外后果。对获取特定药品的限制可能会导致合理和不合理的药物替代效应；尚不清楚此类限制是否会降低药品或整体医疗保健的支出。
