Are Medicaid Closed Formularies Unethical?
Resource allocation, Access to care, Equitable care
Sturm College of Law
State Medicaid programs have proposed closed formularies to limit spending on drugs. Closed formularies can be justified when they enable spending on other socially valuable aims. However, it is still necessary to justify guidelines informing formulary design, which can be done through a process of decision making that includes the public. This article examines criticisms that Medicaid closed formularies limit deliberation about decisions that affect drug access and unfairly disadvantage poor patients. Although unfairness to poor patients is a risk, it is not a problem unique to Medicaid, since private insurance programs have also implemented closed formularies.
Leah Rand & Govind Persad, Are Medicaid Formularies Unethical?, 21 Am. Med. Assoc. J. Ethics 654 (2019).