Related Experiment Videos
Medicaid managed care prescription use and cost savings
Theresa I Shireman1, Richard W Hornung, Mona Ho
1School of Pharmacy, University of Kansas, Lawrence 66045-7582, USA. tshireman@rx.pharm.ukans.edu
Objective:
To evaluate the impact of Medicaid managed care (MC) enrollment on prescription use and costs.
Design:
Retrospective, cross-sectional analysis of claims submitted over a 6-month period.
Setting:
Ohio Medicaid.
Patients And Other Participants:
Stratified, random selection of 2,932 MC and 1,335 fee-for-service (FFS) recipients.
Main Outcome Measures:
Dependent variables were the probability of any prescription use and 6-month prescription counts and costs. Independent variables included age, plan enrollment (MC or FFS), county enrollment status (mandatory or voluntary), presence of a chronic comorbidity, and any outpatient medical visit.
Results:
After adjusting for comorbidities and outpatient medical visits, plan enrollment effects depended on age. FFS enrollees 8 to 12 and 12 to 18 years old were less likely (adjusted odds ratios 0.56 and 0.58, respectively) to receive a prescription, while enrollees over 30 years of age were 2.98 times more likely to receive a prescription. Among prescription users, level of use and costs were consistent across all ages for MC enrollees. FFS enrollees had 25% to 218% higher levels of prescription use than MC enrollees, depending on age. Prescription costs were 8% lower for FFS enrollees ages 4 to 8 but higher for all enrollees in other age groups (range, 22% to 311% higher).
Conclusion:
Prescription use and costs were lower for Medicaid MC enrollees than they were for patients in traditional FFS plans. Further research is needed to examine the quality of care for both FFS and MC enrollees.