Medicaid preferred drug lists' costs to physicians

Jonathan Ketcham, Andrew J. Epstein

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Medicaid preferred drug lists (PDLs) might reduce costs for Medicaid programs while creating costs to physicians. Objectives: To measure the costs from complying with Medicaid PDLs for primary care physicians and cardiologists, and to quantify the costs of a hypothetical PDL for Medicare Part D. RESEARCH Design: We analyzed cardiologistsĝ€™ and primary care physiciansĝ€™ experiences with Medicaid PDLs for antihypertensives and statins in 9 states. Physiciansĝ€™ prescribing volumes and PDL compliance were generated by combining pharmacy claims data from Wolters Kluwer Health with the state PDLs. These data were augmented with a survey of physicians. A Monte Carlo simulation was used to randomly assign each relevant physician in the state to a survey response. Estimates of the cost of a potential Part D PDL relied on the volume of Part D claims reported by Centers for Medicare and Medicaid Services (CMS) through May 2006. Results: Physiciansĝ€™ PDL-related costs averaged $8.02 [95% confidence interval (CI): $7. 25ĝ€"$8.78] per prescription. Average cost per prescription not covered by the PDL was $14.41 (95% CI: $13.29ĝ€"$15.53), and average cost per prescription covered by the PDL was $6.59 (95% CI: $5. 91ĝ€"$7.28). Medicaid PDL costs per physician averaged $1110 (95% CI: $1061ĝ€"$1161) annually for statins and antihypertensives alone, and this varied across states. Similar restrictions under Medicare Part D across all therapeutic classes would have cost physicians $3.18 billion (95% CI: $2. 88ĝ€"$3.49 billion) in 2006. Conclusions: Medicaid PDLs generate considerable costs to physicians, as would adoption of PDLs in Medicare Part D. Policymakers should weigh these and other costs against the benefits of PDLs.

Original languageEnglish (US)
Pages (from-to)9-16
Number of pages8
JournalMedical Care
Volume46
Issue number1
DOIs
StatePublished - Jan 2008

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Drug Costs
Medicaid
physician
drug
Physicians
Costs and Cost Analysis
costs
Pharmaceutical Preparations
Medicare Part D
Confidence Intervals
confidence
Prescriptions
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Primary Care Physicians
medication
Antihypertensive Agents
Centers for Medicare and Medicaid Services (U.S.)
Compliance
Cost-Benefit Analysis

Keywords

  • Administrative costs
  • Medicaid formularies
  • Medicare part D
  • Physician prescribing patterns
  • Prescription drug coverage

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Medicaid preferred drug lists' costs to physicians. / Ketcham, Jonathan; Epstein, Andrew J.

In: Medical Care, Vol. 46, No. 1, 01.2008, p. 9-16.

Research output: Contribution to journalArticle

Ketcham, Jonathan ; Epstein, Andrew J. / Medicaid preferred drug lists' costs to physicians. In: Medical Care. 2008 ; Vol. 46, No. 1. pp. 9-16.
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AB - Background: Medicaid preferred drug lists (PDLs) might reduce costs for Medicaid programs while creating costs to physicians. Objectives: To measure the costs from complying with Medicaid PDLs for primary care physicians and cardiologists, and to quantify the costs of a hypothetical PDL for Medicare Part D. RESEARCH Design: We analyzed cardiologistsĝ€™ and primary care physiciansĝ€™ experiences with Medicaid PDLs for antihypertensives and statins in 9 states. Physiciansĝ€™ prescribing volumes and PDL compliance were generated by combining pharmacy claims data from Wolters Kluwer Health with the state PDLs. These data were augmented with a survey of physicians. A Monte Carlo simulation was used to randomly assign each relevant physician in the state to a survey response. Estimates of the cost of a potential Part D PDL relied on the volume of Part D claims reported by Centers for Medicare and Medicaid Services (CMS) through May 2006. Results: Physiciansĝ€™ PDL-related costs averaged $8.02 [95% confidence interval (CI): $7. 25ĝ€"$8.78] per prescription. Average cost per prescription not covered by the PDL was $14.41 (95% CI: $13.29ĝ€"$15.53), and average cost per prescription covered by the PDL was $6.59 (95% CI: $5. 91ĝ€"$7.28). Medicaid PDL costs per physician averaged $1110 (95% CI: $1061ĝ€"$1161) annually for statins and antihypertensives alone, and this varied across states. Similar restrictions under Medicare Part D across all therapeutic classes would have cost physicians $3.18 billion (95% CI: $2. 88ĝ€"$3.49 billion) in 2006. Conclusions: Medicaid PDLs generate considerable costs to physicians, as would adoption of PDLs in Medicare Part D. Policymakers should weigh these and other costs against the benefits of PDLs.

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