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This report is a case study of five states' (California, Georgia, Oklahoma, Oregon, and Washington) implementation of prior authorization in their Medicaid programs. REPORT Download
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. Findings show that plans rely on a number of cost management strategies to constrain the growth in drug spending including formularies, tiered-copayments, mail-order benefits, and fixed caps or dollar limits…
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. The article provides an historical overview and current U.S. Food and Drug Administration regulation of advertising prescription drugs directly to consumers. The article also…
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. For more information on the series see the National ADAP Monitoring Project page. Issue Brief
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. In fiscal year 2003, some 21 states are planning to expand or create prior authorization systems where the state must provide pre-approval before selected drugs can be dispensed to…
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. Providers would be required to obtain prior authorization from the state to prescribe any drug not included on the MPPL. Background Paper
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. The study is based on survey responses of 435 large private-sector firms (1,000+ employees) that currently offer retiree health benefits, and includes 36% of all Fortune 100 companies and 28% of all Fortune 500 companies. Information was collected on a variety of topics including costs, premiums, retiree…
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. The current Featured Topic contains additional trends in public knowledge and attention to news about seniors and prescription drugs, as well as public opinion about who should be covered by a Medicare prescription drug benefit and what constitutes a good plan. Report Topline & Methodology
An updated fact sheet summarizing the latest statistics and trends regarding the role of Medicaid in providing prescription drug coverage. Fact Sheet
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. Policy Brief
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