Drug use behavior under the constraints of a Medicaid prescription cap

Limiting the number of prescriptions reimbursed per month is a cost-containment measure used by state Medicaid programs. The purpose of this study was to identify and examine the strategies used by patients who exceed the limits of the cap. Nineteen patients identified by community pharmacists as meeting this criterion were interviewed in their homes by a member of the project team. The sample consisted predominantly of women. Seven of the 19 individuals reported that they had altered the way they took their medication, primarily by reducing the frequency of dosing, to make the medication last longer. Eight individuals reported that, at some time during the past year, they did not obtain a prescribed medication because of the prescription cap. These medications were prescribed for a variety of conditions, including diabetes, asthma, and congestive heart failure. Patients made the purchase/nonpurchase decision based primarily on importance of the condition for which the medication was prescribed. What was deemed important, however, could change over time as a result of changing symptoms. Patients obtained some help from friends, family, and health care professionals in coping with the constraints of the prescription cap. However, the cap forced a significant group of patients into noncompliance, and thus placed them at risk for poor health outcomes.