|
Schizophrenic patients in Maine's Medicaid program were subjected to more frequent interruptions in treatment when the state began requiring physicians to seek prior authorization before prescribing certain schizophrenic medications not on the programs' preferred drug list, according to a new study published online in the April, 2008 online edition of Health Affairs. The policy was also found to provide no or minimal government cost savings.
The study, led by investigators from Harvard Medical School's Department of Ambulatory Care and Prevention, looked at Maine Medicaid beneficiaries with schizophrenia on antipsychotic drugs before, during, and after a policy that required patients to use an authorized medication (step treatment) before they were allowed to use drugs not on the preferred list. They were compared to similar beneficiaries in New Hampshire, where there was no prior authorization regulation. The Maine policy was replaced by a provider education program after less than a year.
"This study calls into question the effectiveness of many similar policies throughout the country," says Stephen Soumerai, Harvard Medical School professor and senior author on the study. "Getting prior authorization requires paperwork and is time-consuming, so physicians may tend to switch to prescribing preferred medications even if they have concerns about the appropriateness of the medication for a specific patient." However, as medication choice is restricted, more patients discontinue treatment.
Prior authorization policies for antipsychotic drugs are used in about forty percent of state Medicaid programs and in one-third of the Medicaid Part D drug benefit as a cost-saving measure. While these policies generally have the intended effect of reducing use of non-preferred medications, some seriously mentally ill patients may discontinue or disrupt treatment if they are unable to tolerate the preferred medications. Previous studies indicate that gaps in antipsychotic medication use are likely to result in recurrence of psychotic episodes and higher hospitalization rates and costs for these patients.
Schizophrenia is a disabling and costly illness that afflicts approximately one percent of the US population, or three million people. Without antipsychotic treatment, about 80% of patients will have a serious recurrence of their illness within a year. The study investigators believe that while there is a legitimate place for prior-authorization and step-treatment policies, patients with chronic mental illness are put at particular risk of receiving inadequate treatment.
"Given the tremendous variation in individual responses to these drugs as well as the devastating impact of treatment disruptions on schizophrenic patients, a policy that pushes all patients toward a limited number of preferred drugs may do more harm than good," says Dr. Soumerai. "It would be much better to focus on ensuring that antipsychotic drugs are prescribed for evidenced-based reasons and that preferred drugs are prescribed only to patients who can benefit from them."
|
