Pharmacy Utilization and the Medicare Modernization Act

March 2005 | Vittorio Maio, Laura Pizzi, Adam R. Roumm, Janice Clarke, Neil I. Goldfarb, David B. Nash, David Chess

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.

Author(s): Vittorio Maio; Laura Pizzi,; Adam R. Roumm; Janice Clarke; Neil I. Goldfarb; David B. Nash; David Chess

Keywords: pharmacy utilization management; seniors; cost-sharing mechanisms; administrative restriction tools

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Volume 83, Issue 1 (pages 101–130)
DOI: 10.1111/j.0887-378X.2005.00337.x
Published in 2005