Procedural Prescription Denials and Risk of Acute Care Utilization and Spending Among Medicaid Patients.

ABSTRACT:

Importance

Rising prescription medication costs under Medicaid have led to increased procedural prescription denials by health plans. The effect of unresolved denials on chronic condition exacerbation and subsequent acute care utilization remains unclear.

Objective

To examine whether procedural prescription denials are associated with increased net spending through downstream acute care utilization among Medicaid patients not obtaining prescribed medication following a denial.

Design, setting, and participants

This cross-sectional study used Medicaid claims data from 2022 to 2023 for patients at inpatient, outpatient, and pharmacy sites of care across 2 states (Virginia and Washington) and 2 independent health plans. Patients with at least 1 prescription denial in the

SUBMITTER: Muralidharan B 

PROVIDER: S-EPMC11783194 | biostudies-literature | 2025 Jan

REPOSITORIES: biostudies-literature