Medicaid program

The Supreme Court allows a Maine law to go into effect that requires drug companies participating in the state Medicaid program to pay supplemental rebates. The rebates reduce the costs of prescription drugs for non-Medicaid drug users. 

In his JAMA editorial, Coyle offered another reason for the increase in prescription drug use in that age group. He explained that reduced financing for state Medicaid programs have caused those programs to limit what they pay for the evaluation of behavioral disorders in children. 

Many third parties hire pharmacy benefit managers (PBMs) to provide prescription claims processing and other services. Examples of third parties that hire PBMs are insurance companies, employers, Medicare prescription drug plans, and state Medicaid programs. PBMs establish pharmacy networks as part of their claims management services, so many pharmacy third-party contracts are with PBMs. Examples of other ser-... 

A significant concern in pharmacy is the level of reimbursement specified in these contracts. In 2000, the average third-party reimbursement for a prescription was 15 percent lower than what a patient would pay for the prescription without third-party reimbursement (USDHHS, 2000). This difference may have increased in recent years because third-party payers have continued to decrease their reimbursement rates. There also are substantial differences in reimbursement rates across third-party payers. For example, many state Medicaid programs reimburse at far better rates than private third-party payers. 

Recent studies of overall pediatric use have shown a 6- to 20-fold increase in prescription of atypical antipsychotics in four state Medicaid-programs and, nationally, a sixfold increase in pediatric visits that included prescriptions of antipsychotic medication, more than 90% of which were prescriptions for atypical antipsychotics. 

Anyway, the whole idea of pitching to doctors was starting to lose some appeal. As of 1997, the industry had another marketing weapon—direct TV advertising to consumers. And while HMOs and state Medicaid programs didn t have the clout some had predicted, they did limit somewhat doctors ability to determine what drugs their patients took. 

Like Medicaid, SCRIP is administered by the CMS. It is also a joint federal-state program, with the federal government matching state expenditures at a rate more favorable than under the Medicaid program. Similar to Medicaid, SCHIP is administered by the states under broad federal parameters. 

Kaiser Commission on Medicaid and the Uninsured (2001b). The Medicaid Program at a Glance. Washington, D.C. The Henry J. Kaiser Family Foundation. 

Private or public sector (self-funded employers, insurance companies or health plans, and Medicare or Medicaid programs)... 

The second major change in the nation s health policy during this fourth phase in the evolution of pharmacy practice was the establishment of fhe Medicare and Medicaid programs in 1965, as amendmenfs fo fhe Social Security Act. 

State parhcipation in the Medicaid program is voluntary however, since 1982, all states participate in the program. For each state, the federal government funds at least 50% and up to 83% of the costs of Medicaid, depending on the state s per capita income. States that agree to participate in Medicaid must provide its beneficiaries a minimum set of health care resources, which include the following ... 

The Medicare and Medicaid programs have had a significant impact on the prachce of pharmacy. The Medicare program stimulated the growth of the hospital pharmacy profession. Only those hospitals with a pharmacy department that was directed by a pharmacist and met a minimum set of federal sfandards could receive federal funding for Medicare reimbursement. °... 

For communify pharmacists, the new Medicaid program had a tremendous impact on the pharmacy profession, which is still seen in today s community pharmacies. The establishment of Medicaid created millions of new prescriphons fhaf needed to be filled in a beneficiary s local pharmacy and for which fhe pharmacy would be reimbursed. With the increased number of prescriphons, however, came many addihonal administrahve fasks. These fasks included negohating pharmacisf reimbursement levels staying... 

Creation of U.S. Medicare and Medicaid Programs Medicare Stimulated the growth of hospital pharmacy positions Medicaid Created demand for millions of prescriptions Created administrative issues Created prepaid third-party prescription payment systems... 

Each violation of the Anti-kickback Statute carries the potential for a 25,000 criminal fine, a civil fine, or up to 5 years imprisonment, or all of these. The court may also impose repayment of the amount of losses sustained by the government. Additionally, exclusion from participation in all Medicare and Medicaid programs is required for individuals or corporations convicted of violating the Anti-kickback Statute. 

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