A CRITICAL ANALYSIS OF STUDIES OF STATE DRUG REIMBURSEMENT POLICIES -RESEARCH IN NEED OF DISCIPLINE

Concerns over pharmaceutical costs and appropriateness of medication u se have led state Medicaid programs to restrict drug reimbursement. Th is article critically reviews 20 years of research on cost sharing, dr ug reimbursement limits, and administrative limitations on access to p articular drugs via formularies, category exclusions, or prior authori zation requirements; evaluates their methodological rigor; summarizes the state of current knowledge; and proposes future research direction s. Drug reimbursement caps and modest cost sharing can reduce the use of both essential and less important drugs in Medicaid populations; se vere reimbursement caps may precipate serious unintended effects. Limi tations on access to particular drugs can cause both rational and irra tional drug substitution effects; it is unclear whether such limits re duce expenditures either for drugs or for overall health care.