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This report details the rules governing prior authorization programs and the major steps in a model process based on key issues raised by beneficiary advocates, provider groups and states.
Understanding how Medicare+Choice (M+C) plans manage their drug benefits may generate important lessons for Medicare. This report, based on interviews with both national and regional managed care firms, provides an in-depth look at how plans have managed their M+C outpatient pharmacy benefits in recent years.
This article, which appears in the Food and Drug Law Journal, vol. 57, no. 3, 2002, pp. 423-444 was based on a report written by F.B. Palumbo and C.D. Mullins at the University of Maryland School of Pharmacy Center on Drugs and Public Policy and funded by the Kaiser Family Foundation.
This issue brief, prepared as part of the National ADAP Monitoring Project, examines ADAP formulary coverage of medications for the prevention and treatment of AIDS-related Opportunistic Infections across states, including trends in coverage and expenditures over time, and discusses some of the potential reasons for variations in coverage.
States are grappling with a fiscal crisis that threatens funding for Medicaid, the federal-state partnership that provides health coverage for low-income populations. Two new studies shed light on the impact of an increasingly popular strategy - prior authorization - being used to control prescription drug spending.
Case Study: Michigan's Medicaid Prescription Drug Benefit This report describes the legislative process behind and content of Michigan's Pharmaceutical Product List (MPPL), a selection of preferred drugs available to be prescribed in the Medicaid program with little restriction.
This report presents findings from a study of large private-sector employers conducted by researchers at Hewitt Associates and the Kaiser Family Foundation between July and September of 2002.
A broad and informative bimonthly report, the new Kaiser Health Poll Report provides key tracking information, including historical trends and in-depth analysis of public opinion about hot health care topics.
An updated fact sheet summarizing the latest statistics and trends regarding the role of Medicaid in providing prescription drug coverage.
This policy brief includes background information on Medicaid and its drug benefit, provides examples of how states are using the cost containment mechanisms at their disposal and addresses issues surrounding beneficiary access to outpatient drugs.
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