BACKGROUND The Medicare Modernization Act of 2003 requires drug plan sponsors to provide medication therapy management programs (MTMPs) to beneficiaries with (1) drug expenditures above $4,000, (2) multiple comorbidities, and (3) multiple prescription drugs. The Medical Expenditure Panel Survey (MEPS) is a national probability survey conducted annually by the Agency for Healthcare Research and ...

The findings show that with the development of a multitude of safe and effective drugs during the later part of the 20th century and the beginning of the 21st century, drugs are, as never before, a true mainstay of medical treatment. CMS continues to monitor drug utilization and expenditures in all of its programs in order to ensure that care is rendered in a cost-effective manner that is benef...

Legislation proposed in the 100th Congress and debated during the summer of 1987 would cover prescription drug spending by Medicare enrollees after the enrollee had met a deductible. However, at the time that the legislation was proposed, there were no comprehensive estimates of the extent of current expenditures for prescription drugs by that population, nor of the expected cost of the propose...

OBJECTIVE To estimate medical expenditures attributable to diabetes ketoacidosis (DKA) and severe hypoglycemia among privately insured insulin-treated U.S. youth with diabetes. RESEARCH DESIGN AND METHODS We analyzed the insurance claims of 7,556 youth, age ≤ 19 years, with insulin-treated diabetes. The youth were continuously enrolled in fee-for-service health plans, and claims were obtained...

BACKGROUND Commentaries on the adequacy of insurance coverage for prescription drugs available to Canadians have emphasized differences in the coverage provided by different provincial governments. Less is known about the actual financial burden of prescription drug spending and how this burden varies by province of residence, affluence and source of primary drug coverage. METHODS We used dat...

BACKGROUND Healthcare system reform of Sanming city has become a leading healthcare reform model in China. It has developed a rigorous pharmaceutical reform consisted of the Zero Mark-up Drug Policy and the Centralized Procurement of Medicine Policy to bring down drug expenses and total health expenditures. However, despite the credit and much attention have been given to Sanming's pharmaceutic...

The holy grail of healthcare financing is a system that insures access to health care of appropriate intensity that is provided as e ciently as possible so as to control the growth of overall expenditure. Global budgeting systems can e↵ectively control the growth of overall expenditures by setting a cap on total reimbursements to providers. However, the e↵ect on the intensity or e ciency of car...

BACKGROUND Children's exposure to secondhand smoke is associated with increased morbidity. We estimated Medicaid expenditures for children living with smokers compared to those living with no smokers in the United States. METHODS Data were overall and service-specific (i.e., inpatient, ambulatory, emergency department, prescription drug, and dental) annual Medicaid expenditures for children 0...