Sedative Hypnotic Use by the Mentally Ill: A Medicaid Prescription Policy Study

描述（由申请人提供）：失眠是精神疾病（MI）患者的常见症状，包括抑郁症、焦虑症、注意力缺陷多动障碍（ADHD）和精神分裂症；失眠影响功能和心理健康治疗的结果。有效治疗失眠已被证明对该人群的治疗结果、健康和生活质量有积极影响。2,4 -7国家医疗补助主任认为，失眠药物的使用是一个需要评估的关键问题，因为他们在实施针对镇静催眠药的准入政策后，担心低剂量非典型抗精神病药物的支出和替代8我们将开发一个汇总的多州医疗补助数据集，以研究与精神药物处方获取政策实施相关的卫生服务利用（包括精神药物利用）的变化。我们将首先使用该数据库来研究MI患者处方镇静催眠处方药的处方和非处方使用情况。我们将对合作州科罗拉多州、俄勒冈州和堪萨斯州的使用趋势进行实施前/实施后政策分析，比较三种镇静催眠药物使用限制政策（首选药物清单、事先授权和费用分摊）的影响。每个州的分析队列是所有被诊断为心肌梗死的人。用于亚分析的诊断特异性亚组是患有抑郁症、焦虑症、多动症和精神分裂症的人。我们将量化政策实施对总队列和诊断特定亚组的药物和服务利用、替代和支出的影响。具体目标1：在2002-2007年三个州的医疗补助计划中，在患有精神疾病的医疗补助受益人中，比较较新的镇静催眠药单独使用和与其他精神药物联合使用的趋势。具体目标2：检查处方获取政策对新型镇静催眠药物使用的影响，每个州的前后政策实施情况，以及其他精神药物（如低剂量非典型抗精神病药物）的潜在替代品。具体目标3：比较实施处方获取限制政策对精神健康诊断的医疗补助受益人总体处方药支出和服务利用支出的影响，政策实施前后。

DESCRIPTION (provided by applicant): Insomnia is a common symptom in individuals with mental illness (MI), including depression, anxiety disorders, attention deficit hyperactivity disorder (ADHD) and schizophrenia; insomnia affects both functioning and mental health treatment outcomes.1-4 Effective treatment of insomnia has been shown to positively impact treatment outcomes, health and quality of life in this population.2, 4-7 State Medicaid Directors identify the utilization of insomnia drugs as a critical issue needing evaluation because of concerns about expenditures and substitution to low-dose atypical antipsychotics after they implement access policies directed at sedative hypnotics.8 We will develop a pooled multi-state Medicaid dataset to study changes in health service utilization (including psychotropic medication utilization) associated with psychotropic prescription access policy implementation. We will initially use this database to study prescription and non-prescription utilization by individuals with MI prescribed sedative hypnotic prescription drugs. We will conduct a pre/post-implementation policy analyses of utilization trends within the collaborating states of Colorado, Oregon and Kansas, comparing the impact of three sedative hypnotic access restriction policies (preferred drug lists, prior authorization and cost sharing). Each state's analysis cohort is all people with an MI diagnosis. Diagnosis-specific subgroups for sub-analyses are people with depression, anxiety disorders, ADHD and schizophrenia. We will quantify the effect of policy implementation on medication and service utilization, substitution and expenditures in the total cohort and the diagnosis-specific subgroups. Specific Aim 1: Among Medicaid beneficiaries with a mental illness, compare utilization trends of newer sedative hypnotics, alone and in combination with other psychotropics, across three state Medicaid programs from 2002-2007. Specific Aim 2: Examine the effects of prescription access policies on the utilization of newer sedative hypnotics, pre-to-post policy implementation in each state, and potential substitutions to other psychotropic drugs such as low dose atypical antipsychotics. Specific Aim 3: Compare the impact of implementing prescription access restriction policies on overall prescription drug expenditures and service utilization expenditures among Medicaid beneficiaries with a mental health diagnosis, pre- and post-policy implementation. PUBLIC HEALTH RELEVANCE: We will develop a pooled multistate Medicaid dataset in order to study health care utilization changes associated with psychotropic drug access policy design, implementation and utilization in Colorado, Kansas and Oregon. We will initially use this database to study prescription drug and service utilization of individuals with mental illness that take sedative hypnotic prescription drugs. Research on the impact of prescription access restrictions on the utilization of prescription and non-prescription services, and overall healthcare expenditures, will permit Medicaid programs to refine prescription benefit design, as well as implement psychotropic prescription access policies that optimize health status and maximize the yield of each health care dollar.