Medicaid prescription drug policies and medication access and continuity: findings from ten states.
OBJECTIVE
The aims of this study were to compare medication access problems among psychiatric patients in ten state Medicaid programs, assess adverse events associated with medication access problems, and determine whether prescription drug utilization management is associated with access problems and adverse events.


METHODS
Psychiatrists from the American Medical Association's Masterfile were randomly selected (N=4,866). Sixty-two percent responded; 32% treated Medicaid patients and were randomly assigned a start day and time to report on two Medicaid patients (N=1,625 patients).


RESULTS
A medication access problem in the past year was reported for a mean+/-SE of 48.3%+/-2.0% of the patients, with a 37.6% absolute difference between states with the lowest and highest rates (p<.001). The most common access problems were not being able to access clinically indicated medication refills or new prescriptions because Medicaid would not cover or approve them (34.0%+/-1.9%), prescribing a medication not clinically preferred because clinically indicated or preferred medications were not covered or approved (29.4%+/-1.8%), and discontinuing medications as a result of prescription drug coverage or management issues (25.8%+/-1.6%). With patient case mix adjusted to control for sociodemographic and clinical confounders, patients with medication access problems had 3.6 times greater likelihood of adverse events (p<.001), including emergency visits, hospitalizations, homelessness, suicidal ideation or behavior, or incarceration. Also, all prescription drug management features were significantly associated with increased medication access problems and adverse events (p<.001). States with more access problems had significantly higher adverse event rates (p<.001).


CONCLUSIONS
These associations indicate that more effective Medicaid prescription drug management and financing practices are needed to promote medication continuity and improve treatment outcomes.
American Psychiatric Institute for Research and Education Psychiatric Practice Research Network, American Psychiatric Association, 1000 Wilson Blvd., Arlington, VA 22209, USA. jwest@psych.org
Joyce C
JC
West
Joshua E
JE
Wilk
Donald S
DS
Rae
Irvin S
IS
Muszynski
Maritza Rubio
MR
Stipec
Carol L
CL
Alter
Karen E
KE
Sanders
Stephen
S
Crystal
Darrel A
DA
Regier
D000293:Adolescent; D000328:Adult; D002391:Catchment Area, Health; D003266:Continuity of Patient Care / Q000331:legislation & jurisprudence*; D011307:Drug Prescriptions / Q000592:standards*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000331:legislation & jurisprudence*; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000534:rehabilitation; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011329:Prisoners / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D011619:Psychotropic Drugs