Medicaid prescription cost containment and schizophrenia: a retrospective examination.
OBJECTIVE
In 2002, the Mississippi Division of Medicaid enacted several policies to curb prescription spending including increasing prescription copayments from $1 to $3 per brand, a cap of 7 prescriptions per month, a 34-day supply limitation, and a 5% reduction in dispensing fees. The objectives of this study were to examine the influence of these policies on (1) compliance to antipsychotic medications and (2) mental health care utilization and payments among patients with schizophrenia.


METHODS
This study used a 12-month pretest and 12-month posttest longitudinal design to compare the effect of these policies among patients with schizophrenia in Minnesota and Indiana, who had less restrictive cost-containment using administrative claims data. Generalized estimating equations were used to run difference in difference models to compare medication compliance (proportion of days covered) and health care utilization in Mississippi to the control states.


RESULTS
After policy adoption, patients in Mississippi were 4.87% less compliant with antipsychotic treatments and experienced 20.5% more 90 day antipsychotic treatment gaps than patients in the control states. Although these policies did not affect inpatient or emergency department care among patients with schizophrenia, there was a 3.7% reduction in outpatient mental health visits and a 4.2% reduction in mental health care payments.


CONCLUSIONS
Despite the potential for savings, policy makers should consider carefully the potential adverse consequences that may arise from implementing aggressive cost-containment policies among patient with severe mental illness.
Farley
Joel F
JF
Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. jffarley@unc.edu
D000328:Adult; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003363:Cost Control / Q000379:methods; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008922:Mississippi; D012189:Retrospective Studies; D012559:Schizophrenia / Q000188:drug therapy*; D012959:Socioeconomic Factors; D014481:United States; D016903:Drug Monitoring
D014150:Antipsychotic Agents