States may be driving up health care costs and failing to provide patients with the safest and most effective medicines available, according to a new study that examined which drugs are covered under Medicaid.
Under Medicaid, states receive federal funding to provide a safety net for low-income people. Each state administers its own program, such as Medi-Cal in California, and so each decides which drugs to cover.
Researchers from the University of California, San Francisco, compared the drugs approved under Medicaid in 40 states with the World Health Organization’s “essential medicines list” — 350 medicines approved on the basis of safety, efficacy and cost-effectiveness — and found that many states are not following the WHO’s guidelines.
"This study suggests that if states used the World Health Organization Essential Medicines List as a starting point, it might reduce the number of medicines available to Medicaid patients, but patients could have more confidence that the medicines they receive are effective and safe," Dr. Lisa Bero, one of the study’s authors, said in a statement.
While states’ drug lists did contain most of the WHO’s “essential medicines,” they also included 249 medicines not recommended by the organization that were less likely to have cheaper, generic versions.
The study recommended the creation of a national medicines list and a more transparent, consistent drug-listing methodology. But Bero said she doesn't think that's likely to happen. “Medicaid is administered on a state level,” she said, so "it would be very, very unusual for a federal mandate to tell the state what to have in terms of Medicaid coverage."
Medicaid currently provides health coverage for 20 percent of the population, or 60 million U.S. residents. Under federal health care reform, that coverage is expected to expand, meaning states' choices of which drugs to cover under Medicaid will affect even more people.
The U.S. spends more than any other country on health care — approximately $2.6 trillion in 2010.