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State Pharmacy Programs: Assistance Designed to Target Coverage and Stretch Budgets

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Report Type Reports and Testimonies
Report Date Sept. 6, 2000
Report No. HEHS-00-162
Subject
Summary:

All state pharmacy programs provide benefits for low-income elderly residents, but specific eligibility rules differ and the amount of cost sharing varies widely across programs. States attempt to provide access to drugs and manage program costs through coverage restrictions such as dollar caps on benefits, deductibles, copayments, and limits on the types of drugs covered. All state programs obtain rebates from drug manufacturers; most state programs receive manufacturers' rebates that are calculated on terms similar to rebates under the Medicaid program. To administer the program, states have developed adequate systems to administer benefits and coordinate payment with and recovering payment from other insurers. They have also tried to remove the stigma associated with assistance programs. However, administering programs using Medicaid systems allows states to avoid duplicating program functions, such as eligibility determination and claims processing and adjudication.

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