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Determinants of Change in Medicaid Pharmaceutical Cost Sharing: Does Evidence Affect Policy?
Author(s) -
Soumerai Stephen B.,
RossDegnan Dennis,
Fortess Eric E.,
Walser Bryan L.
Publication year - 1997
Publication title -
the milbank quarterly
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 101
eISSN - 1468-0009
pISSN - 0887-378X
DOI - 10.1111/1468-0009.00043
Subject(s) - medicaid , teachable moment , cost sharing , business , disadvantaged , affect (linguistics) , public economics , harm , medical prescription , public relations , actuarial science , medicine , nursing , political science , economics , psychology , economic growth , health care , social psychology , communication , psychoanalysis
Since 1980, many Medicaid programs have instituted, adjusted, or abolished pharmaceutical copayments or limitations on the number of prescriptions per patient (caps). Studies indicate that prescription caps can harm patients and increase Medicaid costs. However, because there is little information on how state policy makers select and evaluate such policies, in‐depth telephone interviews were conducted with key informants in Medicaid programs that had recently made changes in cost‐sharing policies. Among the barriers to evidence‐based policy making were lack of political power, skills, and infrastructure; crisis‐oriented decisions; compartmentalized budgeting; lack of advocates for disadvantaged patients; and the absence of timely research. Research was applied successfully when the interests of patient advocates and the drug industry were aligned and when Medicaid analysts were able to identify and communicate relevant research to policy makers at the time, or “teachable moment,” that policy was being changed.