Half of Medicaid Beneficiaries With Schizophrenia Do Not Use Antipsychotics

Nearly half of patients with schizophrenia insured by Medicaid in 2018 did not have a claim for an antipsychotic medication, and just one of eight had a claim for any long-acting injectable antipsychotic (LAI), according to a study published in the Journal of Medical Economics.

“These low rates are of particular concern given the demonstrated clinical advantages of LAIs in preventing hospitalization or relapse,” researchers wrote, “and their recommendation across US schizophrenia treatment guidelines.”

The study looked at claims for 688,437 Medicaid beneficiaries with schizophrenia from 45 states in 2018.

Across all states, the antipsychotic utilization rate was 51%. By state, the rate ranged from 24% to 77%, according to the study. Utilization of LAIs was 13% across all states and, for individual states, ranged from 4% to 26%.

Within 30 days of hospitalization, 22% of patients nationally had an outpatient visit (by state, the proportion ranged from 8% to 58%), and the rate of readmissions was 12% (by state, 4% to 48%). Just over a third of patients nationally had one or more hospital admissions in 2018 (by state, 19% to 82%), and 45% had one or more emergency department visits (by state, 20% to 70%), the study found.

Annual total health care costs averaged $32,920 per patient, researchers reported. By state, per-patient health care costs ranged from $717 to $93,972 that year.

“These findings may indicate considerable disease burden and suboptimal pharmacotherapy support among Medicaid beneficiaries with schizophrenia,” the study concluded. “Across states, health care measures varied considerably, implying regional differences in availability or delivery of care, including access to pharmacological treatment.”

Reference:
Patel C, Pilon D, Gupta D, et al. National and regional description of healthcare measures among adult Medicaid beneficiaries with schizophrenia within the United States. J Med Econ. 2022;25(1):792-807. doi:10.1080/13696998.2022.2084234