State Initiatives to Control Medicaid Drug Costs

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Abstract
Mello et al. (Feb. 5 issue)1 describe initiatives to control states' expenditures for drugs, including multiple mechanisms for forcing physicians to obtain approval to prescribe drugs. Physicians working to provide appropriate treatment thereby become grubbing middlemen between Medicaid and manufacturers, having to negotiate or plainly beg for coverage. Although the goal of prior-authorization programs is to reduce costs by eliminating inappropriate prescribing, the programs impede both inappropriate and appropriate prescribing. Physicians facing complex medical decisions in the small amount of time between visits must shift their attention to discuss indications for drugs with insurers. These clerical tasks hinder care.

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