Pharmacy utilization and the Medicare Modernization Act.
To control expenditures and use medications appropriately, the Medicare drug coverage program has established pharmacy utilization management (PUM) measures. This article assesses the effects of these strategies on the care of seniors. The literature suggests that although caps on drug benefits lower pharmaceutical costs, they may also increase the use of other health care services and hurt health outcomes. Our review raises concerns regarding the potential unintended effects of the Medicare drug program's PUM policies for beneficiaries. Therefore, the economic and clinical impact of PUM measures on seniors should be studied further to help policymakers design better drug benefit plans.
Maio
Vittorio
V
Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA. vittorio.maio@jefferson.edu
Pizzi
Laura
L
Roumm
Adam R
AR
Clarke
Janice
J
Goldfarb
Neil I
NI
Nash
David B
DB
Chess
David
D
D000368:Aged; D011307:Drug Prescriptions / Q000191:economics; D017723:Drug Utilization Review / Q000331:legislation & jurisprudence; D006801:Humans; D007342:Insurance Benefits / Q000331:legislation & jurisprudence; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence*; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D007356:Insurance, Pharmaceutical Services / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D011203:Poverty / Q000706:statistics & numerical data; D011332:Privatization / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D014481:United States