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Medicaid Prescription Drug Policies and Medication Access and Continuity: Findings From Ten States

Dr. West, Mr. Rae, Dr. Rubio Stipec, and Dr. Regier are affiliated with the American Psychiatric Institute for Research and Education Psychiatric Practice Research Network, and Mr. Muszynski and Ms. Sanders are with the Division of Healthcare, Systems, and Finance, all at the American Psychiatric Association, 1000 Wilson Blvd., Arlington, VA 22209 (e-mail: jwest{at}psych.org). Dr. Wilk is with the Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, Maryland. Dr. Alter is with the Department of Psychiatry, Georgetown University, Washington, D.C. Dr. Crystal is with the Center for Pharmacotherapy, Rutgers University, New Brunswick, New Jersey.

OBJECTIVES: 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.

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				H. A. Huskamp, J. C. West, D. S. Rae, M. Rubio-Stipec, D. A. Regier, and R. G. Frank Part D and Dually Eligible Patients With Mental Illness: Medication Access Problems and Use of Intensive Services Psychiatr Serv, September 1, 2009; 60(9): 1169 - 1174. [Abstract] [Full Text] [PDF]

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