Examining Policy, Enabler and Access factor effects on US State Medicaid Pharmaceutical Utilization and Expenditures.

Prescription drug expenditures and utilization are the fastest and most widely varying expenditures within Medicaid programs across US states. The passage of the Affordable Care Act (ACA) in 2010 and the subsequent Medicaid state expansions resulted in very large coverage gains among several demographics at the state level. A number of studies prior to ACA highlighting determinants of health utilization and expenditures have been identified and studied discreetly, however, the relationships among these determinants, and the latent constructs of policy, access, enabling health system and predisposing characteristics have not been tested concurrently in relation to drug expenditures
Data from the Centers for Medicare and Medicaid Services ( CMS), US Department of Labor , Department of Education, and state Medicaid programs were merged to create a balanced panel data (n=350 observations and 53 variables over a seven ( 7) period from 2009 to 2015); and was analyzed using random effects (RE) panel regression analysis to estimate a model for drug expenditure across US state Medicaid programs.
Based on Andersen’s Behavioral Model of Health Services, and using a Structure Equation Modeling the study also examined the relationships between and tested the hypothesized effects of policy, access and predisposing factors on State Medicaid expenditures. Findings on effects of cost containment policies, ACA expansion, access to health care facilities and demographic distribution within Medicaid and an econometric model that estimates state drug expenditures are included followed by discussions, limitations and future directions for research