Mental Health

Medicaid drug restrictions may lead to adverse events for psychiatric patients

Patients who suffer from depression, schizophrenia, or other psychiatric ailments often need medications to manage their conditions. However, to keep Medicaid drug costs low, many States employ cost-control strategies, including preferred drug lists, prior authorization requirements, mandated use of generic drugs, medication limits, and step therapies. Yet these cost-control strategies can make getting medications problematic for patients with psychiatric conditions, causing them to experience sometimes-dangerous adverse events, finds a new study.

After surveying 857 psychiatrists in 10 States about medication access for their 1,625 Medicaid patients, researchers found that 48 percent of patients reported at least 1 problem in getting medications. A quarter of the patients stopped taking their medications because of the hurdle. For example, 34 percent of patients were not able to obtain refills or new prescriptions, because Medicaid did not cover them. For 29 percent of patients, clinicians were not able to prescribe certain drugs, such as second-generation antipsychotics or sedatives, either because Medicaid did not cover them or the patient could not afford a copayment.

Overall, 72 percent of patients with psychiatric problems who had trouble obtaining their medications ultimately experienced an adverse event compared with 49 percent of patients who did not have trouble getting their medications. Adverse events included emergency visits, psychiatric hospitalizations, suicidal behavior, homelessness, and incarcerations.

Cost-control practices varied among the 10 States, with New York, Texas, and California having the fewest medication access problems. The authors suggest that these States' policies deserve examination, because they do not overly constrain patient access to prescriptions with the cost-control measures that were studied. This study was funded in part by the Agency for Healthcare Research and Quality (HS16097).

See "Medicaid prescription drug policies and medication access and continuity: Findings from ten states," by Joyce C. West, Ph.D., Joshua E. Wilk, Ph.D., Dondal S. Rae, M.A., and others in the May 2009 Psychiatric Services 60(5), pp. 601-610.

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