Thursday, June 02, 2005

The Use of Oregon's Evidence-Based Reviews for Medicaid Pharmacy Policies: Experiences in Four States A report, in Adobe Acrobat format, from the Kaiser Commission on Medicaid and the Unisured that "explores how four state Medicaid programs — Washington, Wyoming, Minnesota, and North Carolina — differ in their use of Oregon’s Drug Effectiveness Review Project (DERP) to manage their prescription drug benefit." See also the related press release from the NMHA, KFF Paper on Evidence-Based Reviews for Medicaid Pharmacy Policies Reiterates Concerns of NMHA and Other Health Advocates - "In the face of budget pressures, states are increasingly turning to “effectiveness research,” such as that provided by Oregon’s Drug Effectiveness Review Project (DERP), to help design pharmacy benefit policies. ... Despite the important issues inherent in DERP reports raised by KFF that require state decision-maker attention, the National Mental Health Association remains concerned about the potential misuse of these reports. NMHA has long held that research reviews can be an important part of pharmacy benefit management; however, states have a responsibility to use research reviews as only one component of a full spectrum of information necessary to design effective and fair policies that drive the quality of care for vulnerable Americans with chronic illnesses, like mental illness..."  
  

The Effect of Increase Cost Sharing in Medicaid Report from the Center on Budget and Policy Priorities - "Recent policy discussions concerning ways to change Medicaid often include the idea of letting states increase the amounts that low-income beneficiaries are charged in the form of cost-sharing (i.e., in premiums, deductibles, co-insurance, and co-payments). Proponents of increased cost-sharing maintain it would make Medicaid more like private health insurance and promote “personal responsibility,” by making people accountable for a larger share of the cost of their care. Medicaid already permits cost-sharing on a limited basis. Those who advocate increased cost-sharing generally seek flexibility to raise the amounts that can be charged and to apply cost-sharing to groups of beneficiaries that currently are exempted. Changes in Medicaid’s cost-sharing rules could mean charging higher copayments when a patient sees a doctor or picks up a prescription or charging monthly premiums to participate in Medicaid. This analysis highlights key research about the impact of cost-sharing on low-income families and individuals, including recent evidence about how cost-sharing has affected low-income Medicaid beneficiaries in states that have increased their cost-sharing levels..." The report is also available in PDF format.  
  

Out-Of-Pocket Medical Expenses for Medicaid Beneficiaries Are Substantial and Growing Report from the Center on Budget and Policy Priorities - "Federal and state officials are discussing possible ways to reduce Medicaid expenditures. One commonly mentioned proposal is to increase the copayments that poor Medicaid beneficiaries must pay when receiving medical care. A related proposal would reduce the benefits that Medicaid covers for some groups. A rationale offered for these changes is that Medicaid policies are outdated and have not kept pace with changes in the private market. Many assume that because cost-sharing in Medicaid is limited, low-income Medicaid beneficiaries pay almost nothing and bear little financial responsibility for their health care. The analysis presented here shows, however, that the amounts that Medicaid beneficiaries pay out-of-pocket for medical care already are substantial and are growing twice as fast as their incomes. The data also indicate that out-of-pocket expenses have been growing significantly faster for poor adults on Medicaid than for people with private health insurance..." The report is also available in PDF format.  
  

Governors Back Away From Medicaid Cuts Panel AP story in the Las Vegas Sun - "Governors working on proposals to improve Medicaid decided Wednesday they won't join a federal commission that's supposed to recommend how to trim $10 billion from the joint federal-state health care program for the poor. The executive committee of the National Governors Association unanimously agreed that governors would continue their Medicaid work independently of the commission being set up by Michael Leavitt, secretary of the Health and Human Services Department. Association staff would assist the commission, however. Congressional Democrats last week announced they wouldn't be part of the commission being set up by Leavitt at the behest of Congress. Democratic leaders said they were opposed to the $10 billion reduction in spending..."