State Medicaid Prescription Drug Practices Linked To Worse Outcomes For Patients With Mental Illness

Main Category: Mental Health
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 04 May 2009 - 5:00 PDT

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Certain state Medicaid practices intended to save money, such as prior authorization, were associated with increased adverse outcomes among mentally ill patients, according to a new study of nearly 600 psychiatrists and more than 1,600 patients.

The study, "Medicaid Prescription Drug Policies and Medication Access and Continuity: Findings from Ten States," appears in the May 2009 issue of Psychiatric Services, a publication of the American Psychiatric Association.

Medicaid prescription practices, such as requiring a switch to generics; placing limits on the number or dosing of medication; requiring prior authorization; and requiring use of step therapy or fail-first protocols, were associated with a greater number of adverse events in patients, the study found. States with more prescription drug management practices in place had significantly higher medication access problems. After adjusting for patient case mix, patients with medication access problems had a 3.6 times greater likelihood of experiencing a significant adverse event.

"State prescription drug policies may have a major impact on outcomes for patients with mental illness," said Joyce C. West, Ph.D., M.P.P., senior scientist with the American Psychiatric Institute for Research and Education. "Medicaid prescription drug management policies that are based primarily on cost rather than clinical considerations may result in significant human, economic, and social costs."

The study looked at prescription drug management features in ten state Medicaid programs; at medication access problems among psychiatric patients in those ten states; and at adverse events in those patients including emergency room visits, hospitalizations, homelessness, suicidal ideation or behavior, or incarceration.

The most common medication access problems among patients identified by the psychiatrists were:

- Patient could not access clinically indicated medication refills or new prescriptions because Medicaid would not cover or approve them (34%);
- Physician could not prescribe preferred medication because of drug coverage or approval issues or patient could not make copayments (29%);
- Medication discontinued as a result of prescription drug coverage or management issues or problem with copayments (26%);
- Patient prescribed a medication not clinically preferred because clinically indicated or preferred medications were not covered or approved (25%); and
- Patient experienced problems accessing medications because of copayments (14%).

According to the study, patients with problems with copayments had a nearly eight times greater likelihood of experiencing an adverse event. All of the access problems were associated with increased emergency visits and psychiatric hospitalizations. Of the 10 states studied, New York, Texas and California had the lowest rates of access problems, and Ohio, Florida, Massachusetts, Pennsylvania, Tennessee, Georgia and Michigan all had higher rates.

Study authors included Joyce C. West, Ph.D., M.P.P.; Joshua E. Wilk, Ph.D.; Donald S. Rae, M.A.; Irvin S. Muszynski, J.D.; Maritza Rubio Stipec, Sc.D.; Carol L. Alter, M.D.; Karen E. Sanders, M.S.; Stephen Crystal, Ph.D., and Darrel A. Regier, M. D., M.P.H.

About the American Psychiatric Association

The American Psychiatric Association is a national medical specialty society whose more than 38,000 physician members specialize in diagnosis, treatment, prevention and research of mental illnesses including substance use disorders. Visit the APA at http://www.psych.org and http://www.HealthyMinds.org.

Source
American Psychiatric Association

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