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WASHINGTON (AP) - One in four Medicaid patients say they couldn't afford to fill a prescription in the last year, a study finds, even though Medicaid covers prescription drugs in every state.

In this sense, Medicaid patients face the same problems as the uninsured, even though they have health insurance, say researchers at the Center for Studying Health System Change, a health policy research group.

The problem is particularly acute in states that have severely restricted access to drugs in their Medicaid programs in an attempt to control costs.

"The findings are surprising because Medicaid is expected to ensure access to affordable care for the poorest and sickest Americans," Len Nichols, vice president of the center, said in a statement. "This study raises serious questions about the impact of state efforts to control Medicaid drug spending."

The findings are based on an ongoing national survey of about 60,000 Americans living in 33,000 families. Overall, 26 percent of Medicaid beneficiaries said they couldn't afford to fill a prescription at least once in the past year. Of those with no insurance at all, 29 percent said the same.

Most of the attention in Washington has concerned drug coverage for the elderly, who are covered by Medicare, but just 8 percent of those patients said they had not filled a prescription due to cost.

The study also examined the impact of cost containment rules in state Medicaid programs. Some common restrictions include requiring small co-payments, limiting the number of prescriptions one person can fill, requiring generic versions of drugs, requiring prior approval for certain drugs and requiring doctors to try cheaper drugs before prescribing more expensive alternatives.

The study found that patients who lived in states with more restrictions were more likely to face trouble affording drugs. In 27 states, plus the District of Columbia, researchers had data on state policies as well as survey responses. They found:

In four states with zero or one cost-control measure in place, 15 percent of respondents had trouble paying for a prescription.

In 19 states with 2 or 3 measures, 25 percent had trouble.

In four states, plus DC, with 4 or 5 measures, 33 percent had trouble.

Copyright 2002 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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