LOS ANGELES — Restricting access to second-generation or “atypical” antipsychotics led to decreased use of all antipsychotics from 1999 to 2008, according to new research from the Schaeffer Center for Health Policy and Economics at USC.
“Atypical” or second-generation antipsychotics are new medications introduced in the 1990s for the treatment of schizophrenia and other serious mental illnesses. Between 1999 and 2005, spending by Medicaid per patient for antipsychotic drugs increased by 106 percent in the states studied, and the number of prescriptions per patient grew by 29 percent. Over the same time, spending on antidepressants grew by 33 percent and the number of antidepressant prescriptions grew by 53 percent, the study found.
Given their rising cost, atypical antipsychotics and other psychotherapeutic drugs are increasingly subject to restrictions in state Medicaid programs through “utilization management” programs. About 63 percent of states in 2008 used utilization management for atypical antipsychotics. These programs required patients to try conventional or less expensive medications first, or to obtain prior authorization from the plan, before using drugs not on a preferred list.
In the December 2011 issue of Health Affairs, researchers from the Schaeffer Center of Health Policy and Economics at USC and their collaborators looked at data from thirty states. They found that in states that adopted prior authorization policies, use of atypicals rose more slowly than in states where use was not restricted, though not all states subjected the same drugs, or the same number of antipsychotics, to prior authorization.
But restricting access to atypicals was not fully offset by use of conventional antipsychotics, according to the study.
In states with prior authorization for atypical antipsychotics, overall antipsychotic use fell by an average of about 3.1 percent. For the two leading atypical antipsychotics, instituting prior authorization reduced drug use by about 35 percent, and reduced overall use of any antipsychotic — whether another atypical or a conventional antipsychotic — by 6 percent.
“If the reduction in the use of atypicals leads — through decline in overall antipsychotic use — to more poorly controlled schizophrenia in already vulnerable populations, this potentially could have quite severe cost implications,” said senior author Dana Goldman, Norman Topping Chair in Medicine and Public Policy at USC, and director of the Schaeffer Center at USC. “However, if most of the reductions in antipsychotic use were shown to be reductions in inappropriate use, then using prior authorization could produce benefits to patients in addition to cost savings for Medicaid.”
The lead author of the study is William Vogt, associate professor of economics at the University of Georgia. Authors also include Geoffrey Joyce, director of health policy at the Schaeffer Center at USC; Jing Xia, a doctoral student in economics at Harvard University; and George Wan, senior director of health economics and outcomes research, Diabetes Franchise, and Riad Dirani, senior director for immunology, both with Janssen Pharmaceuticals.
Janssen Pharmaceuticals co-funded the study. The research is supported by the National Institutes of Health.
About the Schaeffer Center for Health Policy and Economics at USC
The mission of the Schaeffer Center at USC is to promote health and value in healthcare delivery through innovative research and policy in the United States and internationally.
Contact: Suzanne Wu at (213) 740-0252