Certain state Medicaid practices intended to save money, such as prior authorization, were associated with increased adverse outcomes among mentally ill patients, according to a new study of nearly 600 psychiatrists and more than 1,600 patients….
Medicaid prescription practices, such as requiring a switch to generics; placing limits on the number or dosing of medication; requiring prior authorization; and requiring use of step therapy or fail-first protocols, were associated with a greater number of adverse events in patients, the study found. States with more prescription drug management practices in place had significantly higher medication access problems. After adjusting for patient case mix, patients with medication access problems had a 3.6 times greater likelihood of experiencing a significant adverse event….
According to the study, patients with problems with copayments had a nearly eight times greater likelihood of experiencing an adverse event. All of the access problems were associated with increased emergency visits and psychiatric hospitalizations. Of the 10 states studied, New York, Texas and California had the lowest rates of access problems, and Ohio, Florida, Massachusetts, Pennsylvania, Tennessee, Georgia and Michigan all had higher rates….