Medicaid now consumes more resources than any other state program; this is a significant point, because education expenditures have been surpassed for the first time in many states. This is occurring at the same time that the U.S. Congress has established the Medicaid Commission to examine and recommend policy changes to reduce the federal government’s Medicaid bill by $10 billion over the next five years. Previous efforts had focused on pharmacy reimbursement through cuts in dispensing fees and product reimbursements. Additional measures to curb expenditures include restricting access to certain medications, although this will probably reduce prescription expenditures through shifting costs to other areas, such as Medicare Part A and Part B programs.

The state of Florida is experimenting with a Medicaid preferred drug list that includes only the two lowest-cost products for each therapeutic category. Access to medications that are not on this list will be significantly restricted.
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Other approaches to easing the financial burden include moving Medicaid beneficiaries to managed care organiza-tions—which includes a unique option available under the MMA of special needs plans (SNPs) for the dually eligible. These plans appear to be ideal from an integrated approach because of their responsibility not only for Medicaid but also for Medicare Parts A, B, and D.

Another approach includes the expansion of group-purchasing organizations. The second multistate purchasing pool was approved by DHHS. Louisiana, Maryland, and West Virginia have established their pool, as have Alaska, Hawaii, Michigan, Minnesota, Montana, Nevada, New Hampshire, and Vermont. It is hoped that these pools will reduce prescription costs through volume purchases.

In the future, Medicaid programs are likely to be under increased pressure to reduce prescription expenditures within the Medicaid-only population, which will comprise mainly women and children, because the elderly, the disabled, and patients with end-stage renal disease are removed from this group. canadian cialis

States will find themselves in the difficult situation of either moving toward relinquishing control of their dual eligibles or pushing to regain some of the control that they have lost as a result of the MMA—while at the same time refocusing their Medicaid pharmacy program on the needs of the Medicaid-only beneficiaries. Some level of control over the dual eligibles is essential to ensure that Medicare PDPs are delivering optimal outcomes not only for dual eligibles but also for the state Medicaid program overall by not shifting costs to the state’s side of the ledger. Only time will tell which direction states will take, but clearly this is a very important milestone.