ArticleBMC health services research2016
Medicaid prescription limits: policy trends and comparative impact on utilization.
Article in BMC health services research, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- Cost-related medication nonadherence in Canada: a systematic review of prevalence, predictors, and clinical impact.Systematic reviews · 2021Pooled it
- Continuity of Medications for Opioid Use Disorder in States With and Without Medicaid Prescription Cap Policies.Medical care · 2026Article
- Association Between Medicaid Prescription Drug Caps And Antiretroviral Adherence Among People Living With HIV.Health affairs (Project Hope) · 2025Article
- Medicaid prescription cap policies and exemptions for medications for opioid use disorder: A process and content analysis.Health affairs scholar · 2025Article
- Association of state medicaid prescription cap policies with trajectories of buprenorphine use for opioid use disorder.Journal of substance use and addiction treatment · 2025Article
- Medicaid prescription cap policies and acute care use and mortality among enrollees with opioid use disorder.Drug and alcohol dependence · 2025Article
- Healthcare Rationing in Public Insurance Programs: Evidence from Medicaid.American economic journal. Economic policy · 2022Article
- Pre and Post-Lockdown Cesarean Deliveries and Perinatal Quality Indicators During the COVID-19 Pandemic.Delaware journal of public health · 2022Article
- Article
- First Maintenance Therapy for Chronic Obstructive Pulmonary Disease: Retrospective Analyses of US and UK Healthcare Databases.Pulmonary therapy · 2022Article
- Association Between Medicaid Prescription Drug Limits and Access to Medications and Health Care Use Among Young Adults With Disabilities.JAMA health forum · 2021Article
- Disparities in insurance coverage among hospitalized adult congenital heart disease patients before and after the Affordable Care Act.Birth defects research · 2021Article
- The impact of the ICD-9-CM to ICD-10-CM transition on the prevalence of birth defects among infant hospitalizations in the United States.Birth defects research · 2019Article
- Prior Authorization Policies and Preferred Drug Lists in Medicaid Plans: Stakeholder Perspectives on the Implications for Youth with ADHD.Administration and policy in mental health · 2019Article
- Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study.Journal of the International AIDS Society · 2019Observational
- Having Medicaid insurance negatively impacts outcomes in patients with head and neck malignancies.Cancer · 2016Article
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMedicaid programs face growing pressure to control spending. Despite evidence of clinical harms, states continue to impose policies limiting the number of reimbursable prescriptions (caps). We examined the recent use of prescription caps by Medicaid programs and the impact of policy implementation on prescription utilization.
methodsWe identified Medicaid cap policies from 2001-2010. We classified caps as applying to all prescriptions (overall caps) or only branded prescriptions (brand caps). Using state-level, aggregate prescription data, we developed interrupted time-series analyses to evaluate the impact of implementing overall caps and brand caps in a subset of states with data available before and after cap initiation. For overall caps, we examined the use of essential medications, which were classified as preventive or as providing symptomatic benefit. For brand caps, we examined the use of all branded drugs as well as branded and generic medications among classes with available generic replacements.
resultsThe number of states with caps increased from 12 in 2001 to 20 in 2010. Overall cap implementation (n = 3) led to a 0.52% (p < 0.001) annual decrease in the proportion of essential prescriptions but no change in cost. For preventive essential medications, overall caps led to a 1.12% (p = 0.001) annual decrease in prescriptions (246,000 prescriptions annually) and a 1.20% (p < 0.001) decrease in spending (-$12.2 million annually), but no decrease in symptomatic essential medication use. Brand cap implementation (n = 6) led to an immediate 2.29% (p = 0.16) decrease in branded prescriptions and 1.26% (p = 0.025) decrease in spending. For medication classes with generic replacements, the decrease in branded prescriptions (0.74%, p = 0.003) approximately equaled the increase in generics (0.79%, p = 0.009), with estimated savings of $17.4 million.
conclusionsAn increasing number of states are using prescription caps, with mixed results. Overall caps decreased the use of preventive but not symptomatic essential medications, suggesting that patients assign higher priority to agents providing symptomatic benefit when faced with reimbursement limits. Among medications with generic replacements, brand caps shifted usage from branded drugs to generics, with considerable savings. Future research should analyze the patient-level impact of these policies to measure clinical outcomes associated with these changes.
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