Jalpa A Doshi1,2, Pengxiang Li1,2, Sunita Desai3, Steven C Marcus4. 1. a Department of Medicine , University of Pennsylvania , Philadelphia , PA , USA. 2. b Leonard Davis Institute of Health Economics, University of Pennsylvania , Philadelphia , PA , USA. 3. c Department of Population Health, Division of Health Care Delivery Science , NYU School of Medicine , New York , USA (Wharton School, University of Pennsylvania, Philadelphia, PA at the time of the study). 4. d School of Social Policy and Practice , University of Pennsylvania , Philadelphia , PA , USA.
Abstract
OBJECTIVE: To assess the impact of Medicaid prescription copayment policies on anti-psychotic and other medication use among patients with schizophrenia. METHOD: The study sample included fee-for-service adult Medicaid patients with schizophrenia. Medicaid claims records from 2003-2005 from 42 states and D.C. were linked with county-level data from the Area Resource File and findings from a state Medicaid policy survey. Patient-level fixed-effects regression models examined the impact of increases in generic copayments and generic/brand copayment differentials on monthly use of anti-psychotic (overall and by generic/brand status) and other non-antipsychotic medications. Medications for hypertension, hyperlipidemia, and diabetes in sub-groups of patients with these comorbidities were also examined. RESULTS: Prescription copayment changes had a statistically significant but small impact on anti-psychotic use. For instance, for every $1 increase in the minimum or generic copayment per prescription, there was a reduction of 1.4 anti-psychotic drug fills per 100 patient months (relative reduction = 1.9%). The generic/brand copayment differential increases also had a minimal impact in changing utilization of first-generation (generic) and second-generation (brand) anti-psychotics. Effects of copayment changes on non-anti-psychotic medication use were substantially higher; for each $1 generic copayment increase, there was a reduction of 23 non-anti-psychotic drug fills per 100 patient months (relative reduction = 10.1%). Similarly, for each $1 increase in the generic/brand copayment differential, there was a reduction of 15 non-anti-psychotic drug fills (relative reduction = 5.6%). Reductions in the number of prescriptions filled for antidiabetics, antihypertensives, and lipid-lowering agents were 4-11-fold higher than corresponding reductions for anti-psychotics. LIMITATIONS: Because federal law requires pharmacists to fill medications for Medicaid patients regardless of the ability to pay, these results may under-estimate the true impact of copayment increases. CONCLUSIONS: Medicaid prescription copayment increases resulted in only a minimal decline in anti-psychotic medication use, but much larger reductions in use of other medications, particularly cardiometabolic medications.
OBJECTIVE: To assess the impact of Medicaid prescription copayment policies on anti-psychotic and other medication use among patients with schizophrenia. METHOD: The study sample included fee-for-service adult Medicaid patients with schizophrenia. Medicaid claims records from 2003-2005 from 42 states and D.C. were linked with county-level data from the Area Resource File and findings from a state Medicaid policy survey. Patient-level fixed-effects regression models examined the impact of increases in generic copayments and generic/brand copayment differentials on monthly use of anti-psychotic (overall and by generic/brand status) and other non-antipsychotic medications. Medications for hypertension, hyperlipidemia, and diabetes in sub-groups of patients with these comorbidities were also examined. RESULTS: Prescription copayment changes had a statistically significant but small impact on anti-psychotic use. For instance, for every $1 increase in the minimum or generic copayment per prescription, there was a reduction of 1.4 anti-psychotic drug fills per 100 patient months (relative reduction = 1.9%). The generic/brand copayment differential increases also had a minimal impact in changing utilization of first-generation (generic) and second-generation (brand) anti-psychotics. Effects of copayment changes on non-anti-psychotic medication use were substantially higher; for each $1 generic copayment increase, there was a reduction of 23 non-anti-psychotic drug fills per 100 patient months (relative reduction = 10.1%). Similarly, for each $1 increase in the generic/brand copayment differential, there was a reduction of 15 non-anti-psychotic drug fills (relative reduction = 5.6%). Reductions in the number of prescriptions filled for antidiabetics, antihypertensives, and lipid-lowering agents were 4-11-fold higher than corresponding reductions for anti-psychotics. LIMITATIONS: Because federal law requires pharmacists to fill medications for Medicaid patients regardless of the ability to pay, these results may under-estimate the true impact of copayment increases. CONCLUSIONS: Medicaid prescription copayment increases resulted in only a minimal decline in anti-psychotic medication use, but much larger reductions in use of other medications, particularly cardiometabolic medications.
Authors: Neela L Penumarthy; Robert E Goldsby; Stephen C Shiboski; Rosanna Wustrack; Patricia Murphy; Lena E Winestone Journal: Cancer Med Date: 2019-12-15 Impact factor: 4.452