Summary
The delivery of health care services in the United States is increasingly influenced by the coverage determinations of third—party payers. This paper reviews 3 specific initiatives recently undertaken by the federal government that relate directly or indirectly to reimbursement for pharmaceuticals. The 3 initiatives, involving new conditions of coverage and incorporating language and policies that signal broader changes for the future, are the Medicaid Prudent Pharmaceutical Purchasing Program enacted as part of the Omnibus Budget Reconciliation Act of 1990, the national coverage criteria proposed by the Health Care Financing Administration, and the Agency For Health Care Policy and Research with its mandate to oversee the development of clinical practice guidelines.
Similar content being viewed by others
References
Coster JM. Medicaid Prudent Pharmaceutical Purchasing Final Provisions — House/Senate Conference Agreement. Presented at the National Health Lawyers Association Workshop, Drugs, Devices, and Biotechnology, Washington, DC, January 17-18, 1991
Drummond M. Australian guidelines for cost—effectiveness studies of pharmaceuticals: the thin end of the boomerang? PharmacoEconomics 1 (Suppl. 1): 61–69, 1992
Editorial. Cost cutting mood on Capitol Hill. Scrip 1597 (March 8): 15, 1991a
Editorial. Medicaid law amendments on hold. Scrip 1629 (June 19): 15, 1991b
Green J, Arno PS. The ‘Medicaidization’ of AIDS: trends in the financing of HIY—related medical care. Journal of the American Medical Association 264: 1261–1266, 1990
Hillman AL, Eisenberg JM, Pauly MY, Bloom BS, Glick H, et al. Avoiding bias in the conduct and reporting of cost—effectiveness research sponsored by pharmaceutical companies. New England Journal of Medicine 324: 1362–1365, 1991
Institute of Medicine. Clinical practice guidelines: directions for a new program, National Academy Press, Washington, DC, 1990
Pollard MR, Coster JM. Savings for Medicaid drug spending. Health Affairs 10: 196–206, 1991
Pryor D. A prescription for high drug prices. Health Affairs 9: 101–109, 1990
Schondelmeyer SW. Medicaid drug prices and expenditures: issues and options. Statement before the Subcommittee on Health for Families and the Uninsured, Committee on Finance, United States Senate, September 17, 1990
Schondelmeyer SW, Thomas J. Trends in retail prescription expenditures. Health Affairs 9: 131–145, 1990
Shulman SR. Clinical practice guidelines and malpractice law: an evolving standard of care. Food Drug Cosmetic Law Journal 46: 97–106, 1991
Spalding BJ. Will costs set coverage? Biotechnology 9: 509, 1991
Special Committee on Aging. Prescription drug prices: are we getting our money’s worth? A majority staff report of the Special Committee on Aging, United States Senate, August, 1989
Wagner J. Office of Technology Assessment. Presented at the National Health Lawyers Association’s workshop. Drugs, Devices, and Biotechnology, Washington, DC, January 17-18, 1991
Wenneker MB, Weissman JS, Epstein AM. The association of payer with utilization of cardiac procedures in Massachusetts. Journal of the American Medical Association 264: 1255–1260, 1990
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Shulman, S.R. The Reimbursement Factor in Pharmaceutical Regulation. Pharmacoeconomics 1 (Suppl 1), 21–27 (1992). https://doi.org/10.2165/00019053-199200011-00007
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199200011-00007