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1994-08-27
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Document 0792
DOCN M9480792
TI Medicaid policies for HIV-related drug therapies: perspectives of the
state affiliates of the American Pharmaceutical Association.
DT 9410
AU Buchanan RJ; Smith SR; Department of Community Health, University of
Illinois, Champaign; 61820.
SO Ann Pharmacother. 1994 Apr;28(4):528-35. Unique Identifier : AIDSLINE
MED/94312742
AB OBJECTIVES: 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. RESULTS: 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. CONCLUSIONS: 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.
DE Comparative Study Human HIV Infections/*DRUG THERAPY
Medicaid/*ECONOMICS Pharmacies/ECONOMICS Prescription Fees
Questionnaires Rate Setting and Review/*STANDARDS *Reimbursement,
Incentive Societies, Pharmaceutical State Health
Plans/*ECONOMICS/LEGISLATION & JURISPRUD Support, U.S. Gov't, P.H.S.
Tuberculosis/DRUG THERAPY/ECONOMICS United States JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).