The social drug lag: an examination of pharmaceutical approval delays in Medicaid formularies.

Several states have enacted restrictive drug formularies in order to control the costs of their Medicaid pharmaceutical programs. This study investigates the restrictiveness of these formularies by analyzing the delay in approving new drug products for Medicaid reimbursement. A restrictiveness index is developed which relates the drug product months which are denied to Medicaid patients to the potential product months of availability if all products which were newly approved for general use were simultaneously made available to the Medicaid population. The study then relates the restrictiveness of state formularies to Medicaid drug program costs and to total Medicaid program costs. We find that restrictiveness of formularies is not associated with lower drug costs, but that total Medicaid costs are lower in states with more restrictive formularies. We suggest that restrictive formularies may occur in states with other Medicaid cost-containment measures, so that total Medicaid expenditures are contained in those states, even though there is no reduction in drug expenditures.

Laser induced surface damage.

A summary of recent investigations of surface damage of transparent dielectrics is presented. Damage threshold measurements made on Owens-Illinois ED-2 laser glass at normal incidence and at Brewster's angle are reported. For 30-nsec pulses at normal incidence, exit surface damage thresholds are typically 100 J/cm(2) for ED-2 glass. The observed ratio between entrance and exit damage thresholds for the two geometries can be explained by considering the electric field strengths at the surfaces and including interference between incident and reflected light waves. A similar analysis is applied to surface damage that occurs during total internal reflection. Finally the morphology of surface damage of ED-2 laser glass is described, and a model based upon reflections from the laser induced plasma is proposed to explain the observations.