Between 2001 and 2005 many states put into place new policies designed to help them manage Medicaid pharmacy costs and expand access to prescription drug coverage. Many of the management strategies, such as preferred drug lists (PDLs), sought to apply clinical evidence to state purchasing to help curtail pharmacy costs while ensuring beneficiary access to needed prescription drugs, since medications—even expensive ones—can be cost-effective and improve quality of life.
In 2004, The Commonwealth Fund funded the National Academy for State Health Policy and Georgetown University to conduct a series of site visits to examine state efforts to manage the pharmacy benefit in Medicaid programs. With input from an advisory group of state officials and other experts, a site visit team selected six states (California, Florida, Kansas, Michigan, Missouri, and Washington) where they met with multiple stakeholders including agency staff, pharmacy vendors, pharmacists, physicians, DUR and P&T committee members, and consumers/advocates. The findings from these visits were used to prepare a final report and series of briefs.
Although the implementation of the new Medicare drug benefit (Part D) in 2006 significantly reduced Medicaid drug costs the lessons learned in successfully applying clinical evidence to prescription drug purchasing may prove useful for new efforts to improve purchasing in other areas.
