Impact of Medicaid Prescription Copayments in Patients with Schizophrenia

描述（由申请人提供）：精神分裂症患者的医疗补助处方共付额的影响为了控制不断上升的处方支出，许多州的医疗补助计划增加了处方共付额，并实施了与药物的通用/品牌状态或成本相关的差异（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，而不同的共同负担费用将鼓励使用较便宜的药物，从而减少支出。这些变化对精神分裂症的医疗补助患者具有特殊意义。抗精神病药物是治疗这种严重精神疾病的主要药物。遵守这些药物是至关重要的，以减少急性精神病发作和精神病住院。从医疗补助计划的角度来看，近年来抗精神病药物已成为最昂贵的药物类别，减少使用或改用仿制药将节省费用。然而，这种变化也可能增加这些脆弱患者不依从或停止抗精神病治疗的风险。本项目旨在了解医疗补助处方共同负担费用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，以及共同负担费用的变化与其他非药物医疗服务使用的意外增加相关的程度。鉴于2000年至2004年期间改变了医疗补助处方共同负担政策的州数量众多，我们将使用前后比较设计与同期对照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他们的州特定处方共同支付政策联系起来。我们将估计一系列计量经济学模型，以检查共同负担水平的增加和品牌/通用共同负担差异的增加对我们的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的结果的影响。我们还将探讨这些共同负担费用的变化如何影响整体和非典型抗精神病药物的使用（即，治疗间隙、停药和转换）。最后，我们将使用我们的研究结果来模拟替代处方共同支付政策的影响，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告知政策制定者关于医疗补助精神分裂症患者处方共同支付的预期和非预期后果。

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.