title: Use of atypical antipsychotic drugs for schizophrenia in Maine Medicaid following a policy change.
abstract: More than one-third of Medicaid programs and Medicare Part D plans use prior authorization (PA) policies to control the use of atypical antipsychotics (AAs). We used Medicaid and Medicare claims data to investigate how Maine's PA policy affected AA use, treatment discontinuities, and spending among schizophrenia patients initiating AA therapy. Patients initiating AAs during Maine's policy experienced a 29 percent greater risk of treatment discontinuity than patients initiating AAs before the policy took effect; no change occurred in a comparison state. AA spending was slightly lower in both states. Observed increases in treatment discontinuities without cost savings suggest that AAs should be exempt from PA for patients with severe mental illnesses.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, in Boston, Massachusetts, USA. stephen_soumerai@hms.harvard.edu
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ball
authors.forename: Robert F
authors.initials: RF
authors.lastname: LeCates
authors.forename: Michael R
authors.initials: MR
authors.lastname: Law
authors.forename: Tom E
authors.initials: TE
authors.lastname: Hughes
authors.forename: Daniel
authors.initials: D
authors.lastname: Chapman
authors.forename: Alyce S
authors.initials: AS
authors.lastname: Adams
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006291:Health Policy; D006801:Humans; D007345:Insurance Claim Review; D008281:Maine; D008297:Male; D008484:Medicaid; D054524:Medicare Part D; D008875:Middle Aged; D009513:New Hampshire; D016016:Proportional Hazards Models; D012559:Schizophrenia / Q000188:drug therapy* / Q000191:economics; D014481:United States; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents