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Area of Science:

  • Health Services Research
  • Psychiatric Pharmacy
  • Health Economics

Background:

  • Medicaid formulary restrictions (FRs) are implemented to control drug spending.
  • Understanding the impact of FRs on patient treatment adherence and outcomes is crucial for schizophrenia management.

Purpose of the Study:

  • To assess how Medicaid formulary restrictions affect the rate at which schizophrenia patients resume previously failed drug therapies.
  • To analyze the unintended consequences of FRs on patient treatment adherence and overall healthcare utilization.

Main Methods:

  • Utilized drug-level data on state Medicaid FRs and claims from noninstitutionalized schizophrenia patients.
  • Employed a difference-in-differences technique to compare changes in adverse outcomes before and after FR adoption versus states without restrictions.

Main Results:

  • Patients often resume the same medication after adverse events, irrespective of FRs.
  • In states with FRs limiting atypical antipsychotics, patients were 20.1% more likely to resume a failed atypical therapy.
  • FRs on all atypicals increased the likelihood of complete treatment discontinuation by 11.6%.

Conclusions:

  • Formulary restrictions may inadvertently lead to patients returning to ineffective treatments or abandoning therapy altogether.
  • While intended to reduce drug costs, FRs might increase the utilization of other healthcare services for schizophrenia patients.
  • The study highlights potential negative impacts of FRs on treatment continuity and patient outcomes in schizophrenia care.