Journal ArticleDOI
Medicaid prescription drug policies and medication access and continuity: findings from ten states.
Joyce C. West,Joshua E. Wilk,Donald S. Rae,Irvin S. Muszynski,Maritza Rubio Stipec,Carol L. Alter,Karen E. Sanders,Stephen Crystal,Darrel A. Regier +8 more
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TLDR
It is indicated that more effective Medicaid prescription drug management and financing practices are needed to promote medication continuity and improve treatment outcomes.Abstract:
Objectives: The aims of this study were to compare medication access problems among psychiatric patients in ten state Medicaid programs, assess adverse events associated with medication access problems, and determine whether prescription drug utilization management is associated with access problems and adverse events. Methods: Psychiatrists from the American Medical Association’s Masterfile were randomly selected (N=4,866). Sixty-two percent responded; 32% treated Medicaid patients and were randomly assigned a start day and time to report on two Medicaid patients (N=1,625 patients). Results: A medication access problem in the past year was reported for a mean±SE of 48.3%±2.0% of the patients, with a 37.6% absolute difference between states with the lowest and highest rates (p<.001). The most common access problems were not being able to access clinically indicated medication refills or new prescriptions because Medicaid would not cover or approve them (34.0%±1.9%), prescribing a medication not clinically preferred because clinically indicated or preferred medications were not covered or approved (29.4%±1.8%), and discontinuing medications as a result of prescription drug coverage or management issues (25.8%±1.6%). With patient case mix adjusted to control for sociodemographic and clinical confounders, patients with medication access problems had 3.6 times greater likelihood of adverse events (p<.001), including emergency visits, hospitalizations, homelessness, suicidal ideation or behavior, or incarceration. Also, all prescription drug management features were significantly associated with increased medication access problems and adverse events (p<.001). States with more access problems had significantly higher adverse event rates (p<.001). Conclusions: These associations indicate that more effective Medicaid prescription drug management and financing practices are needed to promote medication continuity and improve treatment outcomes. (Psychiatric Services 60:601– 610, 2009)read more
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Journal ArticleDOI
Barriers to Prescription Medication Adherence Among Homeless and Vulnerably Housed Adults in Three Canadian Cities
Charlotte E. Hunter,Anita Palepu,Susan Farrell,Evie Gogosis,Kristen O’Brien,Stephen W. Hwang,Stephen W. Hwang +6 more
TL;DR: Homeless and vulnerably housed individuals face significant barriers to medication adherence and health care providers serving this population should be particularly attentive to nonadherence among younger patients and those with harmful or hazardous drinking patterns.
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Estimating the Impact of Adherence to and Persistence with Atypical Antipsychotic Therapy on Health Care Costs and Risk of Hospitalization
Yawen Jiang,Weiyi Ni +1 more
TL;DR: To estimate the impact of adherence to and persistence with atypical antipsychotics on health care costs and risk of hospitalization by controlling potential sources of endogeneity.
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Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans
TL;DR: In this paper, the authors investigated rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota and found that rural enrollees were more likely to report no past year preventive care compared to urban enrollees.
Journal ArticleDOI
Aftercare, emergency department visits, and readmission in adolescents.
Corine Carlisle,Corine Carlisle,Muhammad Mamdani,Muhammad Mamdani,Russell Schachar,Russell Schachar,Teresa To,Teresa To +7 more
TL;DR: It is found that aftercare in the month post-discharge increased the likelihood of readmission but not ED visit, which may indicate a relative lack of psychiatric services for youth.
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Reconceptualizing Medication Adherence: Six Phases of Dynamic Adherence
TL;DR: Changes in the concept of adherence are described, a more comprehensive definition of adherence is presented that recognizes the role of patient‐provider transactions, and dynamic adherence, a six‐phase model, is introduced, which incorporates therole of transactional processes and other factors that influence patients’ adherence decisions.
References
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Journal ArticleDOI
Medicaid policies to contain psychiatric drug costs
TL;DR: This study reviews Medicaid policies to restrict access to psychiatric medications, including policies on prior authorization, preferred drug lists, limitations on the number of prescriptions, fail-first requirements, and use of generics.
Journal ArticleDOI
Medication Access and Continuity: The Experiences of Dual-Eligible Psychiatric Patients During the First 4 Months of the Medicare Prescription Drug Benefit
Joyce C. West,Joshua E. Wilk,Irvin L. Muszynski,Donald S. Rae,Maritza Rubio-Stipec,Carol L. Alter,William E. Narrow,Darrel A. Regier +7 more
TL;DR: Most drug plan features studied, including preferred drug/formulary lists, prior authorization, medication dosing/number limits, "fail-first" protocols, and requirements to switch to generics, were associated with significantly higher rates of medication access problems.
Book
Medicaid: A Primer
TL;DR: The basic elements of Medicaid are described, focusing on federal rules governing who is eligible, what services are covered, how the program is financed and how beneficiaries share in the cost, how providers are paid, and the role of special waivers in expanding eligibility and modifying benefits.
Journal ArticleDOI
Medicaid's prior authorization program and access to atypical antipsychotic medications.
TL;DR: In this article, the authors discuss the roles of Medicaid and other insurers in responding to emerging drug safety issues and their challenges in weighing drug risks and benefits, and discuss the role of state Medicaid programs in dealing with these issues.
Medicaid's Prior Authorization Program And Access To Atypical Antipsychotic
TL;DR: The roles of Medicaid and other insurers in responding to emerging drug safety issues and their challenges in weighing drug risks and benefits are discussed.