Martin B C, McMillan J A
Department of Pharmacy Care Administration, College of Pharmacy, University of Georgia, Athens 30602, USA.
Med Care. 1996 Jul;34(7):686-701. doi: 10.1097/00005650-199607000-00003.
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.
1991年11月1日，佐治亚州医疗救助部门将每月可报销处方的最大数量从6张减至5张。这一政策变化提供了一个自然实验，用以调查受助者对现有处方限额降低的反应。研究设计为对一个队列进行的准实验性、回顾性、为期12个月的中断时间序列分析。该队列由743名高处方量的门诊受助者组成。除了获取所有队列受助者药房生成的计算机资料以确定医疗补助和自付处方费用外，还获得了完整的医疗补助理赔数据。进行了中断时间序列分析，以模拟五项处方限额对八个治疗类别的总处方量、医疗补助报销处方量、自付处方量和处方使用情况的影响。五项处方限额实施后，总处方使用量下降了6.6%，医疗补助报销的处方量下降了9.9%，自付处方量增加了9.7%。心血管、杂类、肺部和姑息治疗药物类别出现了突然、永久性的下降（α = 0.05），而胃肠道、化疗、激素（胰岛素）和中枢神经系统的处方使用量保持不变。实施更严格的处方限额会改变处方用药方案，这可能使老年医疗补助受助者面临临床后果。有必要对这些受助者的健康结果作进一步研究。
