Restricted Medication Access Could Increase Hospitalization, Nonadherence

A recent study was not able to fully determine whether restricted access to atypical antipsychotics reduced overall costs or just shifted the cost to other aspects of the healthcare system.

Due to rising drug costs, a majority of Medicaid programs implement cost containment strategies, such as prior authorizations (PA), preferred drug lists, dispensing limits, use of generics, rebates, cost sharing, and step therapy, according to a study published by the American Journal of Managed Care.

Atypical antipsychotics (AAPs) are typically used to treat schizophrenia and bipolar disorder. These drugs can elicit various responses from different patients.

For a majority of patients, trials of multiple antipsychotics are needed to find their optimal treatment, according to the study; however, restrictions could potentially effect treatment access and patient outcome.

Researchers analyzed 15 peer-reviewed studies that discussed restrictions to antipsychotics and how they effected the patients. The studies included assessed PAs, benefit carve-outs, payment caps, cost sharing, and overall costs.

In the study that discussed payment caps, the researchers found that a cap resulted in a drop in utilization of the drug. They also discovered an increase in visits to community mental health centers and increased utilization of mental health services and partial hospitalization.

For step therapy, a study showed that it decreased drug costs, but it increased costs for outpatient services even more than what was saved. Interestingly, the study found there were less outpatient visits, even though the cost increased.

Another study found that open access to AAPs increased utilization and costs, but decreased nursing home utilization. Multiple studies analyzed found only moderate savings that were offset by increased healthcare utilization.

Other studies showed that PA policies can lead to a reduction in the utilization of nonpreferred AAPs, and result in patients discontinuing treatment. Researchers in the current study found that although these PA programs are common, there is a lack of information about the long-term outcome.

Although initial cost savings may be appealing, it is likely that medication nonadherence, increased healthcare utilization, and poor patient outcomes could occur. Further research is needed to fully understand clinical and economic impacts of restrictions place on AAPs, the study concluded.