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Related Experiment Videos

Information needs for medication coverage decisions in a state Medicaid program.

T W Croghan¹, B M Johnstone, D P Buesching

¹Health Outcomes Evaluation Group, Lilly Research Laboratories, Indianapolis, IN 46285, USA. croghanvthomasvw@lilly.com

|April 27, 1999

Summary

California

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Area of Science:

Health economics
Pharmaceutical policy
Health services research

Background:

Health plans balance innovation access with cost containment.
California's Medicaid program (Medi-Cal) serves a large, diverse mentally ill population.
Medi-Cal utilizes a Therapeutic Class Review (TCR) process for pharmaceutical technology assessment.

Purpose of the Study:

Describe Medi-Cal's TCR information for antidepressants.
Detail Medi-Cal's individual petition review for antipsychotics.
Synthesize experiences into policy recommendations for improved coverage decisions.

Main Methods:

Collaborative evidence generation between Medi-Cal and pharmaceutical manufacturers.
Analysis of Medi-Cal recipient needs and current treatment quality.

Related Experiment Videos

Evaluation of cost-effectiveness for new pharmaceutical treatments.

Main Results:

A substantial body of evidence was developed through collaboration.
Insights were gained into Medi-Cal recipient needs and treatment effectiveness.
Prospects for cost-effective introduction of novel treatments were assessed.

Conclusions:

Medi-Cal employs a structured process for evaluating new medicines.
The TCR process enhances understanding of coverage decision-makers' needs.
Recommendations include increased surveillance and early clinical trial integration.