An analysis of the effect of managed care implementation of prescription drug utilization by Texas Medicaid clients
Abstract
This study measured prescription drug utilization and payment changes when
Texas Medicaid clients in the Bexar County Service Area moved from a fee-forservice
(FFS) to either a health maintenance organization (HMO) or primary care case
management (PCCM) health care delivery model. Drug utilization and payment
patterns were compared for a six-month period before and a six-month period after
the managed care pilot program implementation. Medicaid clients in FFS, HMO, and
PCCM programs in three other geographical areas across the state served as
comparison groups with the experimental groups in Bexar County.
Significant differences across plan designs were found in the mean changes of
the following variables between study periods for child and adult clients: 1)
prescription drug use rates; 2) the proportion of generic drug use; 3) prescription drug
vii
payments per claim; and 4) prescription drug payments per client. Furthermore, these
changes were found to be significantly different across plan designs for child and
adult antibiotic claims, and for child antidepressant claims. Significant differences
were found for the following variables for child and adult antihistamine claims, and
for child NSAID claims: 1) the proportion of generic drug use; 2) prescription drug
payments per claim; and 3) prescription drug payments per client. And for adult
antidepressant and NSAID claims, significant differences were found in the following
variables: 1) prescription drug use rates; 2) the proportion of generic drug use; and 3)
prescription drug payments per client.
This study provided evidence of a managed care spillover effect on the
prescription drug utilization of Medicaid managed care patients with a carved-out
drug benefit. The results of this study should be helpful to Medicaid administrators
who make decisions about managed care programs and carved-out drug benefits
Department
Description
text