Outcomes associated with a state-level health policy change for the atypical antipsychotic class of drugs within the Georgia Medicaid schizophrenic population
Walthour, Amy McMullin
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Background: Schizophrenia is a chronic mental illness affecting approximately 1% of the US population. Currently, pharmacological treatment is the mainstay of therapy for schizophrenia. At nearly $200 million per year, mental health drugs represent a significant component of prescription drug spending within the Georgia Medicaid program. In 2004 the Georgia Medicaid program implemented a prior-authorization policy for the atypical antipsychotic class of drugs resulting in an average savings of $2.7 million per year. Objectives: To determine if implementation of a prior-authorization policy for the atypical antipsychotic drugs resulted in increased healthcare utilization in the Georgia Medicaid Program from July 2003 to April 2006. Research Design: Segmented regression analysis with time series analysis. Subjects: Continuously eligible, adult Georgia Medicaid recipients with a diagnosis of schizophrenia and documented use of an atypical antipsychotic medication. Measures: Four healthcare services utilization endpoints were analyzed in this study: emergency room visits, outpatient office visits, hospital admissions and length of stay. Where applicable, analysis of a non-continuously eligible population was also performed to investigate the possibility of disenrollment bias in significant study results. Results: This study found a significant decline in post-policy trend for the average number of emergency room visits (β3 = -0.0029) and the average number of hospital admissions per member per month (β3 = -0.0010). Baseline starting level and pre-policy trend were also found to be significant predictors for both endpoints. Significant models were not identified for average outpatient office visits per member per month or average length of stay per admission. Conclusions: In contrast to much of the published literature on prior-authorization for the atypical antipsychotics, the results in this study indicate patient outcomes may have actually been improved after the initiation of the policy. To the extent that medical utilization reflects patient health outcomes and health status, the results of this study indicate the program has potentially improved the health of schizophrenic patients in the Georgia Medicaid program and lowered program costs.