OBJECTIVES: Spending on direct-to-consumer advertising (DTCA) has seen exponential growth since the late 1990s. The purpose of this research was to assess the association between DTCA spending and drug utilization and reimbursement in the United States Medicaid market. METHODS: National direct-to-consumer advertising expenditures were obtained from Advertising Age for selected brands in three drug classes: HMG Co-A reductase inhibiting agents (statins), anti-ulcer/GERD medications, and antidepressants. The drug utilization and reimbursement (sales) data were extracted from the national Medicaid pharmacy files provided by the Centers for Medicare & Medicaid Services. The annual advertising expenditures, drug utilization, and reimbursement were charted from 2000 to 2005. Correlation analysis was used to assess the association between both contemporaneous and lagged DTCA spending by pharmaceutical companies and drug utilization and reimbursement for each of the three therapeutic classes. RESULTS: A wide range of estimated Pearson correlation coefficients were derived, including some negative coefficients. The strongest positive correlations were found for the statins and antidepressants for the year 2003. Only antidepressants had a statistically significant correlation (r=0.58, p<0.05) between DTCA and reimbursement/utilization based on a pooled correlation analysis from 2000 to 2005. CONCLUSIONS: Utilization rates and reimbursement in the Medicaid market for the investigated medications were not consistently statistically impacted by DTCA. While there is evidence of a strong correlation for antidepressants, there is less compelling evidence for statins, and none for the anti-ulcer drugs. Although both utilization and expenditures in Medicaid were growing for all three classes, their growth was due to factors beyond DTCA.