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Articles   |    
Medication Continuity Among Medicaid Beneficiaries With Schizophrenia and Bipolar Disorder
Jonathan D. Brown, Ph.D., M.H.S.; Allison Barrett, M.A.; Emily Caffery, B.A.; Kerianne Hourihan, B.Sc., B.A.; Henry T. Ireys, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200349
View Author and Article Information

All authors are affiliated with Mathematica Policy Research, with offices in Washington, D.C. (JDB, AB, and HTI); Ann Arbor, Michigan (EC); and Cambridge, Massachusetts (KH). Send correspondence to Dr. Brown, Mathematica Policy Research, 12th Floor, 1100 First St., N.E., Washington, DC 20024 (e-mail: jbrown@mathematica-mpr.com).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study was conducted to examine whether medication continuity among Medicaid beneficiaries with schizophrenia and bipolar disorder was associated with medication utilization management practices (prior authorization, copayment amounts, and refill and pill quantity limits), managed care enrollment, and other state and beneficiary characteristics.

Methods  With 2007 Medicaid Analytic Extract claims data from 22 states, random-effects logistic regression modeled the odds of high medication continuity, defined as receiving medications for at least 80% of the days enrolled in Medicaid, among beneficiaries ages 18–64 with a diagnosis of schizophrenia (N=91,451) or bipolar disorder (N=33,234).

Results  Sixty-four percent of beneficiaries with schizophrenia and 54% of beneficiaries with bipolar disorder had high medication continuity. Medication continuity was worse among beneficiaries with schizophrenia in states that required prior authorization for antipsychotics, $2–$3 copayments for generic medications, or $1 copayments for branded medications (compared with no copayments). For beneficiaries with bipolar disorder, medication continuity was worse among those in states with more prior-authorization requirements for different classes of medications or $1 copayments for branded medications. Medication continuity was worse among beneficiaries who were African American, Hispanic, younger, or enrolled in a health maintenance organization health plan or who had a comorbid substance use disorder or cardiovascular disease.

Conclusions  Prior-authorization requirements and copayments for medications may present barriers to refilling medications for Medicaid beneficiaries with schizophrenia or bipolar disorder. State Medicaid programs should consider the unintended consequences of medication utilization management practices for this population.

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Figure 1 Selection of states and beneficiariesa

aThe schizophrenia cohort included beneficiaries in 20 states (Alaska, Alabama, California, Connecticut, Georgia, Idaho, Illinois, Indiana, Iowa, Louisiana, Maryland, Mississippi, Missouri, New Hampshire, North Carolina, North Dakota, Oklahoma, South Dakota, West Virginia, and Wyoming) and Washington, D.C. The bipolar disorder cohort included beneficiaries in 16 states (Alabama, California, Connecticut, Georgia, Idaho, Illinois, Indiana, Iowa, Louisiana, Maryland, Mississippi, Missouri, New Hampshire, North Carolina, Oklahoma, and West Virginia) and Washington, D.C.

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Table 1Demographic characteristics of study cohorts of Medicaid beneficiaries with schizophrenia or bipolar disorder in 2007
Table Footer Note

a Received an antipsychotic

Table Footer Note

b Received an antipsychotic, lithium, or an anticonvulsant

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Table 2State Medicaid policies by number of states and beneficiaries
Table Footer Note

a Count includes Washington, D.C.

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Table 3Odds of high medication continuity among Medicaid beneficiaries with schizophrenia or bipolar disorder in 2007
Table Footer Note

a SMHA, state mental health agency; HMO, health maintenance organization

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