Impact of Medicaid Prescription Copayments in Patients with Schizophrenia

医疗补助处方共付额对精神分裂症患者的影响

• 批准号: 7300387
• 负责人: Jalpa A. Doshi
• 金额: $ 48.81万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-06 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7300387
• 关键词: Acute; Address; Adherence; Adopted; Antipsychotic Agents; Behavior; Class; Cost Control; Cost Sharing; Data; Disease; Drug Costs; Drug Prescriptions; Drug Utilization; Econometric Models; Equilibrium; Expenditure; Frequencies; Generic Drugs; Goals; Health Care Costs; Health Services; Hospitalization; Insurance; Link; Medicaid; Mental Health; Mental Health Services; Modeling; Natural experiment; Numbers; Outcome; Patients; Pharmaceutical Preparations; Policies; Price; Public Policy; Relapse; Research Personnel; Risk; Savings; Schizophrenia; Secondary to; Series; Simulate; Symptoms; System; atypical antipsychotic; base; copayment; cost; design; improved; payment; prescription document; prescription procedure; programs; severe mental illness; simulation; tool; trend

DESCRIPTION (provided by applicant): Impact of Medicaid Prescription Copayments in Patients with Schizophrenia To control rising prescription expenditures, many state Medicaid programs have increased prescription copayments and implemented differential (or tiered) copayments tied to the generic/brand status or cost of the drug. The rationale is that higher out-of-pocket payments would reduce unnecessary drug utilization and differential copayments would encourage use of less expensive drugs, leading to decreased expenditures. These changes have particular significance for Medicaid patients with schizophrenia. Antipsychotic drugs are the mainstay therapy for this serious mental illness. Compliance with these drugs is critical to reduce acute psychotic episodes and psychiatric hospitalizations. From a Medicaid program perspective, antipsychotics have become the most costly drug class in recent years, and reduced utilization or switching to generics would result in savings. However, such changes may also raise the risk of non-compliance or discontinuation with antipsychotic therapy in these vulnerable patients. This project aims to understand whether and how Medicaid prescription copayment changes impact antipsychotic medication use in patients with schizophrenia and the extent to which copayment changes are associated with unintended increases in use of other non-drug health care services. Given the large number of states which changed their Medicaid prescription copayment policies between 2000 and 2004, we will evaluate the impact of these changes using a pre-post comparison design with contemporaneous controls. We will link data on patients with schizophrenia across all state Medicaid programs with their state-specific prescription copayment policies. We will estimate a series of econometric models to examine the impact of increases in copayment levels and increases in the brand/generic copay differential on our outcomes of overall and atypical antipsychotic medication use and non-drug mental health services use. We will also explore ways in which these copayment changes impact overall and atypical antipsychotic medication use (i.e., gap in therapy, discontinuation, and switching). Finally, we will use our results to simulate the effect of alternative prescription copayment policies and model the net impact on total mental health care costs for Medicaid programs. The findings of our study will help inform policymakers about the intended and unintended consequences of prescription copayments in Medicaid patients with schizophrenia.

描述（由申请人提供）：医疗补助处方共付额对精神分裂症患者的影响为了控制不断增长的处方支出，许多州的医疗补助计划增加了处方共付额，并实施了与药物的仿制/品牌状态或成本挂钩的差异（或分层）共付额。其理由是，较高的自付费用将减少不必要的药物使用，而差别共付费用将鼓励使用较便宜的药物，从而减少支出。这些变化对接受医疗补助的精神分裂症患者尤为重要。抗精神病药物是治疗这种严重精神疾病的主要药物。依从这些药物对减少急性精神病发作和精神病住院至关重要。从医疗补助计划的角度来看，抗精神病药物已成为近年来最昂贵的药物类别，减少使用或转向仿制药将节省费用。然而，这种改变也可能增加这些易感患者抗精神病药物治疗不依从性或停药的风险。本项目旨在了解医疗补助处方共付额的变化是否以及如何影响精神分裂症患者抗精神病药物的使用，以及共付额的变化在多大程度上与其他非药物卫生保健服务使用的意外增加有关。考虑到2000年至2004年期间许多州改变了他们的医疗补助处方共同支付政策，我们将使用带有同期控制的前后比较设计来评估这些变化的影响。我们将把所有州医疗补助计划中精神分裂症患者的数据与各州特定的处方共付政策联系起来。我们将评估一系列计量经济模型，以检验共同支付水平的增加和品牌/仿制药共同支付差异的增加对总体和非典型抗精神病药物使用和非药物精神卫生服务使用结果的影响。我们还将探讨这些共同支付变化对整体和非典型抗精神病药物使用的影响（即治疗间隙，停药和切换）。最后，我们将使用我们的结果来模拟替代处方共同支付政策的效果，并模拟医疗补助计划对精神卫生保健总成本的净影响。我们的研究结果将有助于决策者了解医疗补助精神分裂症患者的处方共付的预期和非预期后果。