Medicaid patients

The concept of a "secure" prescription form was expanded by the federal government in 2008 to all prescriptions written for Medicaid patients. Any prescription for a Medicaid patient must be written on a security form if the pharmacist is to be compensated for the prescription service. In turn, the use of "triplicate" prescription forms was eliminated and replaced with an online electronic transmission system whereby orders for Schedule II and Schedule III prescriptions are transmitted to a company that acts as a repository for these transactions. In California, it is called the CURES program (Controlled Substances Utilization Review and Evaluation System). Additional information about CURES may be found at http //ag. ca. gov/bne/tri ps. ph p. 

States have responsibility to pay for prescription drugs of Medicaid patients, those persons with too little income and too few resources to pay for their... 

OBRA 90) required that pharmacists idenhfy and resolve drug-related problems before they reached Medicaid patients. Today, this DUR standard is applied not only to Medicaid patients but to all patients receiving health care benefits through a third-party provider (e.g., an insurance company). As such, DUR has had an enormous impact on the current health care system. 

The OIG must exclude any person or corporation convicted of a felony relating to health care fraud from the Medicare program. The law mandates minimum periods of exclusion from 1 to 3 years, depending on the basis for exclusion. For many corporations, it is this debarment from federal programs (more so than any criminal fine) that causes the most fear, as the loss of Medicare and Medicaid patients could ultimately cause the business to fail. 

A prior authorization technique involving non-steroidal anti-inflammatory drugs (NSAIDs) in Medicaid patients was shown to be highly effective. NSAIDs not available genetically were place on prior approval status. This lead to the increased use of genetically available NSAIDs as first line therapy. For a two-year period, the result was a 53 percent decrease in expenditures (S12.8 million) with no concomitant increase in Medicaid expenditures for other medical care. 

As is the case of an HMO patient presenting a card at the pharmacy, the Medicaid patient does the same thing. Each state decides whether it will have a patient copayment, and if so, its amount. About 15 States have no copayment requirement, and the others charge between 50 cents and 3.00 per prescription. 

Pashko S, McCord A, Sena MM. The cost of epilepsy and seizures in a cohort of Pennsylvania Medicaid patients. Med Interface 1993 (November) 84. 

Rascati KL, Johnsrud MT, Crismon ML, et al. Olanzapine versus risperidone in the treatment of schizophrenia A comparison of costs among Texas Medicaid patients. Pharmacoeconomics 2003 21 683—697. 

L. Snyder and J. Weiner. 1996. Ethics and Medicaid Patients. In L. Snyder, ed., Ethical Choices Case Studies in Medical Practice. Philadelphia American College of Physicians, pp. 63-70. 

The power of certain classes of purchasers to exact discounts was recognized by the framers of the 1990 Medicaid Rebate law (Public Law 101-508) which requires manufacturers to offer Medicaid the best price (i.e., lowest price) they offer to private purchasers if the manufacturer wants to sell its products to the Medicaid patient. The strategy may have backfired, however, because manufacturers eliminated many such discounts to HMOs and hospitals when they found that they would lose the amount of the discount on a large part of their total market (431), (Medicaid makes up 10 to 15 percent of the market for outpatient drugs.)... 

Grabowksi, H., Medicaid Patients Access to New Drugs, Health Affairs 7 102-1 14, Winter 1988. 

Children who are at risk should be screened at 12 and 24 months. Blood lead levels tend to be the highest during the second year of a child s life. If a child who is from 3 to 5 years old has never been assessed, he or she should be assessed at least once. All Medicaid patients should be screened at 1 and 2 years of age unless they are in a low-risk area. If an area is determined to be at very low risk, then neither screening nor assessment is recommended. ... 

A further issue that has been used to support the position of surgery has been the notional consideration that antireflux surgery should decrease health care use. A retrospective matched cohort study of Tennessee Medicaid patients compared the costs of medical and surgical treatment for GERD in 1996. The study compared 135 patients who had fundoplication with 250 randomly selected patients from a group of more than 7,000 who were treated medically. 

Dor A, Pylypchuck Y, Shin P, Rosenbaum S. (2008). Uninsured and Medicaid Patients Access to Preventive Care Comparison of Health Centers and Other Primary Care Providers, The George Washington University, Washington, DC. Research Brief 4. RCHN Community Health Foundation Research Collaborative. 

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