These antipsychotics are medications that were 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 increasingly are 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 issue of Health Affairs, researchers from the Schaeffer Center and their collaborators looked at data from 30 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, holder of the Norman Topping Chair in Medicine and Public Policy at USC, and director of the Schaeffer Center. “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 included Geoffrey Joyce, director of health policy at the Schaeffer Center; Jing Xia, doctoral student in economics at Harvard University; and George Wan, senior director of health economics and outcomes research and Riad Dirani, senior director for immunology, both with Janssen Pharmaceuticals.
Janssen Pharmaceuticals co-funded the study. The research was supported by the National Institutes of Health.