Surveying variation in antipsychotic medication policies across state Medicaid programs

1. Methods Abstract Results Conclusions • No conclusions can be made at this time without the surveys being reviewed by each state’s Medicaid official. • This survey will use three different data sources for preliminary information. • The surveys will then be given to state Medicaid officials for their review and notes. • Once the surveys have been reviewed a set of fifty state policy sheets can be developed and related to geographic variation in antipsychotic prescription drug use. • Preliminary results indicate that 14 states have had a change in co-payment from 2001 to 2007. • Preliminary results also indicate that in 2004, 26 states have a preferred drug list and of the 26 states, 15 states exempt antipsychotic drugs. • In 2004, 50 states have a prior authorization policy and of those states, 39 exempt antipsychotic drugs. • Preliminary results suggest 50 states have policies that encourage generics in 2004, however 9 states exclude antipsychotic drugs from the mandate. • 15 states have prescription limits and 5 states exclude antipsychotic drugs from prescription limits. • 20 states have fail first drug policies for antipsychotics. • Background: Geographic variation in medical care is well documented in the United States, but little research has examined the variation in prescription drug use and expenditures. • Objectives: This study is part of a larger study “Variation in Antipsychotic Medication Use and Expenditures across State Medicaid Programs”. The entire study has two aims. The first aim is to provide accurate national and state level estimates of the prevalence, level, type and pattern of antipsychotic medication use and expenditures among all fee-for-service adult Medicaid recipients and variability. The second aim is to determine the impact of state antipsychotic medication policies on antipsychotic use and expenditures. This survey is an in-depth examination of the state Medicaid policies that will be analyzed in the larger study under the second aim. • Methods. This study will link three different data sources including Centers for Medicare and Medicaid Services quarterly data, National Pharmaceutical Council data and a Health Affairs paper published by Koyanagi et al. (2005). The surveys will then be reviewed and completed by state Medicare officials. • Results: The surveys are still being reviewed by Medicaid officials but our preliminary data from the three data sources can be viewed • Conclusions: Until all of the information can be reviewed, no conclusions can be made Background • The Medicaid program is administered individually by each state with funding from the state and federal government • Many states have targeted Medicaid prescription drug spending by following a variety of cost containment strategies from the private sector. • No study has examined the extent of geographic variation across Medicaid programs due to these varied policies Policy Implications • Understanding state Medicaid policy differences will be important to insuring rational prescription policies, efficiency of the Medicaid program and optimal care of Medicaid patients. • These findings will have implications for state policymakers debating further changes in Medicaid prescription policies to control antipsychotic expenditures. Objectives Determine state policies on antipsychotic medication through evaluations of state co-payment, prior authorization, preferred drug lists, generic substitution and behavioral health care plan policies. Relate the role of state Medicaid policies to interstate variation in antipsychotic use and expenditure. Surveying variation in antipsychotic medication policies across state Medicaid programs Jacqueline Chaudhry, Karunya Manikonda, Alex Li, Jalpa A. Doshi PhD University of Pennsylvania, University of Pennsylvania, University of Pennsylvania, University of Pennsylvania