DESCRIPTION (provided by applicant): Medications treating cardiovascular conditions offer important benefits for patients and, when prescribed ideally, can save both lives and money. However, the high cost of many cardiovascular medications concerns insurers, especially in public programs such as Medicaid which face severe budget constraints. Medicaid programs have implemented cost-containment policies to reduce the use of some medications. In doing this, programs seek to limit the use of overly expensive medications without creating adverse clinical consequences by reducing the use of highly effective drugs. The comparative effectiveness of the different approaches used for drug cost-containment policy is not well understood. We will draw on our prior research to identify and classify Medicaid cost-containment policies for cardiovascular drugs based on the manner in which they attempt to change medication use. Using large patient-level Medicaid databases, to which we have already obtained access, we will evaluate the impact of each different policy approach on medication use and clinical outcomes and compare how well different techniques for containing costs can limit medication expenses without causing adverse clinical events. The research team has extensive experience in evaluating drug policy and in working with large claims datasets, ensuring that high-quality studies will be performed, allowing policy makers and decision makers charged with health systems design to evaluate the balance between savings from reduced use of costly medications and possible adverse clinical outcomes when needed drugs are not used. We will focus on four medications classes: (1) antiplatelet agents; (2) statins; (3) antihypertensives; and (4) oral hypoglycemics. We will collect detailed data on Medicaid cost-containment policies for all medications in these classes and categorize them into a classification system derived from our earlier studies. We will evaluate changes in utilization at both the aggregate and individual levels. Our clinical outcomes will be cardiovascular events, including myocardial infarction, stroke, and revascularization. We will evaluate drug utilization outcomes and clinical outcomes in the overall Medicaid programs but will focus in particular on patient cohorts with an indication for the medication affected by a given policy, offering policy-makers a clear sense of how well targeted policies work. By evaluating drug use and clinical outcomes across multiple medication classes, we will develop a thorough depiction of Medicaid reimbursement policy for cardiovascular medications. The findings will provide comparative effectiveness data for these commonly used policy techniques, on which there is limited prior research. Our results will provide critical information for policy makers and delivery system decision makers about both the immediate and longer-term effects of cost-containment policy approaches.
PUBLIC HEALTH RELEVANCE: Policies to control the use of cardiovascular medications are commonly used in public and private programs despite a lack of comparative evidence on whether they achieve savings and how such savings might balance against changes in clinical events. Drawing on years of experience in studying Medicaid policy and using large patient-level Medicaid data sets, we will measure the comparative effectiveness of Medicaid policies on cardiovascular drug spending and assess whether reduced drug use is associated with adverse clinical outcomes, providing critical information for policy-makers and health system design decision makers.