Policies requiring authorization before physicians can prescribe newer medications to schizophrenic patients may be counter-productive.
According to a new study, patients in Maine's Medicaid program who found themselves in this situation were 29% more likely to stop or disrupt medication use than patients not subject to the policy. In addition, although the policy was originally designed to cut costs, government savings were minimal at best.
These findings are reported online in Health Affairs.
The study, led by investigators from Harvard Medical School's Department of Ambulatory Care and Prevention, looked at Maine Medicaid beneficiaries with schizophrenia on antipsychotic drugs before, during, and after a policy that required patients to use an authorized medication (step treatment) before they were allowed to use drugs not on the preferred list. They were compared to similar beneficiaries in New Hampshire, where there was no prior authorization regulation. The Maine policy was replaced by a provider education program after less than a year.
Study data indicated that the original Maine policy disrupted essential antipsychotic treatment for vulnerable patients with schizophrenia, with minimal or no cost savings.
“This study calls into question the effectiveness of many similar policies throughout the country,” says Stephen Soumerai, Harvard Medical School professor and senior author on the study. “Getting prior authorization requires paperwork and is time-consuming, so physicians may tend to switch to prescribing preferred medications even if they have concerns about the appropriateness of the medication for a specific patient.” However, as medication choice is restricted, more patients discontinue treatment.
Previous studies have shown that gaps in antipsychotic medication use are likely to result in recurrence of psychotic episodes and higher hospitalization rates and costs for these patients.