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Trends in Formulary Restrictions for Long-Acting Injectable Antipsychotic Medications Among Medicare Drug Plans,
Samuel R Bunting1, Robert O Cotes1, Kathryn Gray1
1Department of Psychiatry and Behavioral Neuroscience (Bunting, Gray), Department of Pharmacy (Gray), and Pritzker School of Medicine (Chalmers), University of Chicago, Chicago; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta (Cotes); Department of Psychiatry, University of Washington, Seattle (Chalmers); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Nguyen).
Objective:
Long-acting injectable antipsychotics (LAIAPs) enable safe and effective long-term management of chronic psychotic disorders but are underused in clinical practice. The authors examined whether Medicare formulary restrictions (prior authorization [PA] or step therapy) impose barriers to LAIAP uptake.
Methods:
The authors analyzed formulary restrictions and patient cost-sharing for several LAIAPs and estimated the percentage of plans (N=2,494 were available per year) applying formulary restrictions. Analyses were stratified by Medicare Advantage, dual Medicare-Medicaid eligibility plans, and Part D plan group and weighted by the number of enrollees at the per-year, per-plan level.
Results:
Application of formulary restrictions for LAIAPs was low (<12% requiring PA [apart from olanzapine] and <4% requiring step therapy) and decreased among nearly all plan types between 2019 and 2023.
Conclusions:
Formulary restrictions do not appear to present a significant barrier to use of LAIAPs for psychiatric patients with Medicare prescription drug coverage. Additional research is needed to further understand factors influencing LAIAP use.
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