The goal of this research was to determine if the Pharmaceutical Care Services Program (PCSP) significantly changes the utilization and cost of medical services for Medicaid recipients. The University of Maryland Center on Drug and Public Policy (CDPP) has contracted with the Maryland Department of Health and Mental Hygiene (DHMH) to provide pharmaceutical care services for Maryland Medicaid recipients. The main goal of PCSP is to improve the appropriateness and cost-effectiveness of physician prescribing decisions and patient drug use. The program accomplishes this by placing clinical pharmacists in hospital clinics to review drug therapy and provide advice to physicians and counseling to patients. A quasi-experimental pretest and post-test design with three control groups was performed in this study. The subjects who received PCSP and met the study criteria were the study group. The subjects who were Medicaid enrollees and relatively similar to the study subjects in terms of age, sex, hospital, and ACG (ambulatory care group) classification were randomly selected into the control groups by using a multiple computerized matching process. Differences in utilization and cost of medical services between study and control groups were tested for statistical significance. Cost-benefit analyses were then performed from budgetary and societal perspectives by applying a net present value method. The mortality and morbidity productivity loss estimations were specifically addressed as the indirect benefits in this study. Lastly, a sensitivity analysis was performed to test the assumptions (discount rate and wage rate) underlying the analysis. In this study, the utilization and costs comparisons between the PCSP patients and control patients revealed that: (1) PCSP "capped" the total cost of services by holding them constant while the control groups' costs rose sufficiently to create a significant difference between the PCSP and control groups; (2) specialty care physician visits remained stable for PCSP while increasing in the control groups; (3) primary care physician visits remained stable for PCSP recipients while they declined in the control groups; (4) less prescription medication was used in PCSP group than in the control group; (5) while the total cost of prescriptions increased for both groups, the cost of PCSP prescriptions was less than the control group cost; (6) PCSP showed no significant impact on the use of the emergency room and hospitalizations. The cost-benefit analysis illustrates that PCSP saved the Medicaid program $204.32 per patient for the first year intervention and $2,043.20 for the future 10 years from a budgetary perspective. From a societal perspective, PCSP saved society $4,116.01 per patient for the future 10 years period. Theoretically, if PCSP were expanded to serve all Medicaid, adult, non-institutionalized patients receiving drug therapy, the state of Maryland should be able to save as much as $27 million in the next fiscal year from a budgetary perspective. The society should be able to save as much as $259 million in the next fiscal year from both direct and indirect savings.

HIV/AIDS is the most important infectious disease. The significant benefits of new antiretrovirals to HIV/AIDS patients have been documented but these benefits depend on strict patient adherence. Although various published articles have focused on patient non-adherence, most of them have failed to assess the economic and clinical impacts of non-adherence. Maryland Medicaid claims data were used to evaluate risk factors, economic impact and impact of non-adherence on opportunistic infections (OI). The study population included patients who were continuously enrolled in Maryland Medicaid program from the index date to July 30, 1997. The mean non-adherence rate was 20%. Caucasian, male and/or patients who resided in Baltimore County had a significantly lower non-adherence rate compared to their counterparts. In addition, patients treated with protease inhibitor (PI) had a significantly lower non-adherence rate than their counterparts. Race, gender, and resident of Baltimore County were not significantly associated with a ≥95% adherence rate. Age was positively and PI treatment was negatively associated with a ≥95% adherence rate. Results consistently indicate that patients with a ≥95% adherence rate had lower monthly HIV/AIDS-related costs than their counterparts. In addition, Caucasian patients and/or patients with Medicaid and Medicare coverage had a lower monthly cost than their counterparts. However drug dependents had a significantly higher monthly cost than their counterparts. Patients who died, patients with OI and/or patients with severe mental illness had a significantly higher monthly cost than their counterparts. The impact of a ≥95% adherence rate on OI was insignificant. However, the results should be interpreted with caution. Limited sample size and low prevalence of OIs raised the issue of lack of statistical power, which may impede detection of the impact. In conclusion, this study confirms that patient social and clinical factors are significantly associated with non-adherence in a Medicaid HIV/AIDS population. Most importantly, a ≥95% patient adherence rate is associated with a lower monthly cost. The impact of a ≥95% adherence rate on risks of having OI is insignificant which may be due to lack of statistical power. Future studies should assess the clinical impact on more prevalent OIs in a larger patient population.