How similar are states' Medicaid preferred drug lists?
OBJECTIVE
To compare the generosity and consistency of 10 states' Medicaid preferred drug lists (PDLs) in high-volume therapeutic classes.


METHODS
Descriptive comparisons of 7 of the top 10 therapeutic classes by Medicaid sales and of the top 10 most populous states with Medicaid PDLs.


METHODS
A PDL specifies which drugs are available to patients without receiving prior approval from the state. State PDLs were collected in January 2008 to determine the status (covered or not covered) of 110 different drugs in each state. The US Food and Drug Administration Orange Book provided patent status for each drug. States were compared for generosity and similarity of coverage overall, by patent status, and by therapeutic class.


RESULTS
For 42 (38%) of the drugs, there was wide consistency in PDL design, with at least 9 states classifying the drug with the same PDL status. For the other 62% of drugs, there was greater variation, with 2 or more states classifying the drugs differently than the others. Generosity and consistency also varied by therapeutic class and patent status.


CONCLUSIONS
For most drugs, Medicaid PDLs are not implemented consistently across states, suggesting that states do not rely on common clinical evidence to make value-based coverage decisions. Greater involvement by the federal government in designing or regulating monopolistic Medicare Part D PDLs may result in similar inconsistencies.
Ketcham
Jonathan D
JD
WP Carey School of Business, School of Health Management and Policy, Arizona State University, 300 E Lemon St, Tempe, AZ 85287-4506, USA. ketcham@asu.edu
Ngai
Jeffrey K
JK
D005569:Formularies as Topic; D006801:Humans; D008484:Medicaid; D055553:Prescription Drugs; D013221:State Health Plans; D014481:United States
D055553:Prescription Drugs