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

描述（申请人提供）：抑郁症是精神病患者的常见症状，包括抑郁症、焦虑症、注意缺陷多动障碍和精神分裂症;失眠影响功能和心理健康治疗结果。1 -4失眠的有效治疗已被证明对这一人群的治疗结果、健康和生活质量产生积极影响。2，4-7州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，因为他们担心在实施针对镇静催眠药的获取政策后，会出现支出和低剂量非典型抗精神病药替代品的问题。8我们将开发一个汇总的多州医疗补助数据集，以研究卫生服务使用的变化（包括精神药物的使用）与精神药物处方获取政策的实施相关。我们将首先使用这个数据库来研究处方和非处方使用的个人与MI处方镇静催眠处方药。我们将在科罗拉多、俄勒冈州和堪萨斯三个协作州内对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。每个州的分析队列都是诊断为MI的人。用于子分析的特定诊断亚组是抑郁症、焦虑症、多动症和精神分裂症患者。我们将量化政策实施对总队列和特定诊断亚组的药物和服务利用、替代和支出的影响。具体目标1：在患有精神疾病的医疗补助受益人中，比较2002-2007年三个州医疗补助计划中单独使用和与其他精神药物联合使用新型镇静催眠药的趋势。具体目标二：检查处方准入政策对新型镇静催眠药使用的影响，每个州的政策实施前后，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医疗补助受益人的整体处方药支出和服务利用支出的影响，以及心理健康诊断，政策实施前后。 公共卫生相关性：我们将开发一个汇集的多州医疗补助数据集，以研究与精神药物获取政策的设计，实施和利用在科罗拉多，堪萨斯和俄勒冈州的医疗保健利用的变化。我们将首先使用这个数据库来研究服用镇静催眠处方药的精神疾病患者的处方药和服务利用。研究处方准入限制对处方和非处方服务利用率以及整体医疗支出的影响，将允许医疗补助计划完善处方福利设计，并实施精神科处方准入政策，以优化健康状况并最大限度地提高每一美元的医疗保健收益。

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.