Economic effect of an expansion of pharmacy benefits on total health care expenditures by a state Medicaid program.

OBJECTIVES: To evaluate the economic effect of a pharmacy benefit expansion on a population of Oklahoma Medicaid recipients and to determine whether recipients who routinely maximized their monthly prescription limit (cap) before the benefit expansion benefited more from the expansion than the remainder of the study population. DESIGN: Retrospective study. SETTING: Oklahoma Medicaid claims data from January 1, 2003, to December 31, 2004. PATIENTS: Data from 15,936 Oklahoma Medicaid recipients. INTERVENTION: Retrospective administrative analysis using the Oklahoma Health Care Authority pharmacy and medical claims databases. MAIN OUTCOME MEASURES: Total health care expenditures per recipient per year, total medical expenditures per recipient per year, and total pharmacy expenditures per recipient per year. RESULTS: Total health care expenditures increased 17% after the benefit expansion (P < 0.0001). Of this increase, 65% was attributed to pharmacy expenditures and 35% to medical expenditures. However, a subpopulation of recipients who routinely reached their prescription limit before the expansion had a statistically significant increase in total and pharmacy expenditures; a statistically significant increase in medical expenditures was not observed. CONCLUSION: Although total health care expenditures increased after a monthly pharmacy benefit in a Medicaid population was expanded, a subpopulation of recipients identified as high pharmacy users before the expansion did not have a statistically significant increase in medical expenditures, whereas those who were non-high users experienced a significant increase. Additionally, this subpopulation experienced a nonsignificant decrease in hospital expenditures. These results could suggest that this subpopulation was affected differently than the overall population by the expansion of the Medicaid pharmacy benefit.

Disparities in the prevalence of medication therapy for hyperlipidemia in the elderly.

OBJECTIVE: To explore differences in the prevalence of therapy with antihyperlipidemic drugs in patients older than 75 years of age, as compared with patients between the ages of 55 to 74, and other variables. DESIGN: A cross-sectional study. SETTING: Two Oklahoma state-paid pharmacy drug-claims databases. PATIENTS, PARTICIPANTS: The first database contained 69,119 eligible patients 55 years of age and older. The second database contained 82,360 eligible patients 55 years of age and older. MAIN OUTCOME MEASURE(S): Comparison of the prevalence of therapy with antihyperlipidemic drugs in those 55 to 74 years of age with those older than 75 years of age in the data sets, and evaluation of the effect of gender, race, place of residence, and socioeconomic status. RESULTS: In the combined data sets, the group 55 to 74 years of age had a higher prevalence of therapy with antihyperlipidemics than those 75 years of age or older. Men had a higher prevalence of therapy than women, and those in higher socioeconomic status had a higher prevalence, but only in the group 75 years of age or older. Caucasians had a prevalence of therapy greater than African-Americans, but only in the group 55 to 74 years of age or older. CONCLUSIONS: We found that older people were prescribed therapy less frequently than younger people, that women were prescribed therapy less frequently than men, that Caucasians were prescribed therapy more frequently than African-Americans, and that those living in a nursing facility were prescribed therapy less frequently than those living in other settings. Regarding socioeconomic status, only in the younger age group was lower status associated with lower prevalence of prescribed therapy.