Medicaid drug management may reduce access

Patients in states with Medicaid drug utilization management programs reported more drug access problems and adverse events than those in states without such programs, according to a report published in the May issue of Psychiatric Services (link).

Psychiatrists in 10 states reported either a medication access problem or a continuity of care problem for nearly half of their patients in the previous year, said the study, based on a survey of 600 psychiatrists between September and December 2006. Psychiatrists reported the lowest percentage of patient access problems in California, New York and Texas -- about 30% -- compared with about 64% in, Georgia, Michigan and Tennessee.

The physicians most commonly said patients could not access clinically directed medication because the state Medicaid program did not cover the drug or because the program required co-payments for the drug. States most commonly excluded second-generation antipsychotics, sedatives, antidepressants and stimulants, the report said. Patients with an access or continuity problem were 3.6 times as likely to have an adverse event as those who had no problem. Adverse events included hospitalization, emergency treatment, incarceration or homelessness, after adjusting for patient case mix.

"Medicaid prescription drug management policies that are based primarily on cost rather than clinical considerations may result in significant human, economic and social costs," said study co-author Joyce C. West, PhD, MPP, senior scientist with the American Psychiatric Institute for Research and Education. Other study authors are affiliated with Rutgers University Center for Pharmacotherapy, Georgetown University's Dept. of Psychiatry and Walter Reed Army Institute of Research.

But Ann Kohler, director of the National Assn. of State Medicaid Directors, doubted the article was correct. "Generally states do not put limitations on antipsychotic drugs. And when they do put prior authorizations in place, they do dispense any medically necessary drugs," she said.

Study authors acknowledged the report's limitations, including the possibility that physicians whose patients had drug access problems might have been more likely to respond than other doctors. Also, doctors may not have had accurate information on their state's Medicaid drug formularies, which are often complex.