Effect of a Restrictive Formulary on Low Income Children

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DESCRIPTION (provided by applicant): Faced with rapidly rising prescription drug costs, public and private health insurance programs need to manage these costs while still providing access to necessary prescription drug therapy. A major insurer for the Iowa State Children's Health Insurance Program (SCHIP) has implemented a restrictive formulary that with a few exceptions, only covers generic prescription drugs. The formulary will change prescribing patterns, but it is not known whether this change will affect other health care outcomes. The long term goal of the principal investigator is to determine the effect of prescription drug benefit management strategies on health care costs and outcomes. The specific aims of this project are: 1) Determine the effect of the Iowa SCHIP's restrictive prescription drug formulary on children with depression by comparing antidepressant utilization and health outcomes during the year before and the one and a half years after the restrictive formulary was implemented on July 1, 2002. 2) Control for historical trends in depression treatment by comparing antidepressant utilization and health outcomes between Iowa SCHIP, a comparison group of privately insured children and a comparison group of children in the Iowa Medicaid program during the year before and the one and a half years after the restrictive formulary was implemented on July 1, 2002. The study is retrospective and has a pre-test, post-test with comparison group design. Using insurer and Medicaid claims data, various measures of antidepressant utilization and health outcomes will be examined before and after the restrictive formulary was implemented in the HAWK-I group. These variables include: antidepressant claims rate, generic antidepressant utilization rate, antidepressant therapeutic class utilization rate, number of inpatient admissions related to depression, number of physician visits related to depression and number of other health care claims related to depression. Instrumental variable analysis will be used to examine the effect of changes in antidepressant prescribing patterns caused by the restrictive formulary on health care costs.