The nature and consequences of policies intended to contain costs in outpatient drug insurance programs

Abstract

Outpatient drug insurance programs play an important role in making drugs affordable. Public and private program policy-makers often respond to fiscal pressures by reducing benefit coverage or pharmacy reimbursement levels. These reductions defeat both coverage and cost-containment goals. A more prudent approach is to adopt a comprehensive policy for outpatient drug coverage that protects patients and ensures fair and prompt reimbursements to pharmacy providers. These issues are well illustrated by the economic situation in Illinois, resultant state budget problems, and the consequences for the Illinois Medicaid outpatient drug program and the Illinois state-only pharmaceutical assistance program for low-income elderly patients. The questions examined in this paper have important implications for patients, pharmacists, physicians, the pharmaceutical industry, public and private policymakers, and society as a whole.