Cost and utilization of behavioral health medications associated with rescission of an exemption for prior authorization for severe and persistent mental illness in the vermont medicaid program

Journal of Managed Care Pharmacy

Volumn 16, Issue 5, 2010, Pages 317-328

  Simeone, Jason C ^a   Marcoux, Rita M ^a   Quilliam, Brian J ^a  

^a UNIVERSITY OF RHODE ISLAND   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ALPRAZOLAM; AMITRIPTYLINE; ANTIDEPRESSANT AGENT; ANXIOLYTIC AGENT; ARIPIPRAZOLE; BARBITURIC ACID DERIVATIVE; CLOZAPINE; DULOXETINE; HALOPERIDOL; NEUROLEPTIC AGENT; OLANZAPINE; QUETIAPINE; RISPERIDONE; SEDATIVE AGENT; SERTRALINE; ZIPRASIDONE; ZOLPIDEM;

ANXIETY DISORDER; ARTICLE; BIPOLAR DISORDER; DEPRESSION; DISEASE SEVERITY; DRUG COST; HEALTH CARE COST; HEALTH ECONOMICS; HEALTH PROGRAM; HEALTH SERVICE; HOSPITAL PATIENT; HOSPITALIZATION; HUMAN; MEDICAID; MEDICAL RECORD REVIEW; MEDICARE; MENTAL DISEASE; MENTAL HEALTH; PERSONALITY DISORDER; RETROSPECTIVE STUDY; SCHIZOPHRENIA;

EID: 77953303956     PISSN: 10834087     EISSN: None     Source Type: Journal    
DOI: 10.18553/jmcp.2010.16.5.317     Document Type: Article

References (32)

1. Smith VK, Gifford K, Ellis E, Rudowitz R, Watts MO, Marks C. The crunch continues: Medicaid spending, coverage, and policy in the midst of a recession. Results from a 50-state Medicaid budget survey for state fiscal years 2009 and 2010. Kaiser Commission on Medicaid and the uninsured. September 2009. Available at: http://www.kff.org/medicaid/upload/7985.pdf. Accessed May 5, 2010.
2. Holahan J, Yemane A. Enrollment is driving Medicaid costs- but two targets can yield savings. Health Aff (Millwood). 2009;28(5):1453-65.
3. Kimbuende E, Ranji E, Salganicoff A. Prescription drug costs: background brief. Kaiser Family Foundation. February 2010. Available at: http://www.kaiseredu.org/topics-im.asp?id=352&parentID=68&imID=1. Accessed May 5, 2010.
4. U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. National summary of Medicaid managed care programs and enrollment as of June 30, 2008. Available at: http://www.cms.hhs.gov/ MedicaidDataSourcesGenInfo/downloads/08Trends508.pdf. Accessed May 11, 2010.
5. Congress of the United States, Congressional Budget Office. Medicaid's reimbursements to pharmacies for prescription drugs. December 2004. Available at: http://www.cbo.gov/ftpdocs/60xx/doc6038/12-16-Medicaid.pdf. Accessed May 11, 2010.
6. Mechanic D. Managed mental health care. Society. 1997;35(1):44-52.
7. Office of the Inspector General, Department of Health and Human Services. Medicaid's mental health drug expenditures. August 2003. Available at: http://oig.hhs.gov/oei/reports/oei-05-02-00080.pdf. Accessed May 11, 2010.
8. Walton SM, Schumock GT, Lee KV, Alexander GC, Meltzer D, Stafford RS. Prioritizing future research on off-label prescribing: results of a quantitative evaluation. Pharmacotherapy. 2008;28(12):1443-52.
9. Pharmaceutical and Research Manufacturers of America. Pharmaceutical research companies are developing more than 300 medicines to treat mental illnesses. Available at: http://www.phrma.org/files/attachments/ Mental%20Illness%202008.pdf. Accessed April 27, 2010.
10. Dean H. Vermont State of the State Address 2000. January 5, 2000. Available at: http://www.stateline.org/live/details/speech?contentId=16008. Accessed November 20, 2009.
11. General Assembly of the State of Vermont. An act relating to prescription drug cost containment and affordable access. Legislation No. 127 Sec. 1. 33 V.S.A. chapter 19, subchapter 5. Available at: http://www.leg.state.vt.us/DOCS/ 2002/ACTS/ACT127.HTM. Accessed November 13, 2009.
12. State of Vermont Joint Fiscal Office. Evaluation of savings attributable to Medicaid pharmaceutical cost containment. February 2003. Available at: http://www.leg.state.vt.us/JFO/Healthcare/Pharmaceutical%20Savings.pdf. Accessed November 13, 2009.
13. Mulligan K. Vermont gives formulary exemption to psychiatric drugs. Psych News, 2002;37(16):4. Available at: http://pn.psychiatryonline.org/content/37/ 16/4.full. Accessed May 12, 2010.
14. Office of Vermont Health Access, Agency of Human Services. Report: health access oversight committee, pharmacy benefit management program, behavioral health drug management plan. September 2005. Available at: http://ovha.vermont. gov/budget-legislative/haocreport090105.pdf. Accessed May 11, 2010.
15. Perrins G, Nilsen D. Math calculations to better utilize CPI data. Bureau of Labor Statistics. Available at: http://www.bls.gov/cpi/cpimathfs.pdf. Accessed May 5, 2010.
16. Shern DL, Jones K, Chen HJ, Jordan N, Ramoni-Perazzi J, Boothroyd RA. Medicaid managed care and the distribution of societal costs for persons with severe mental illness. Am J Psychiatry. 2008;165(2):254-60. Available at: http://ajp.psychiatryonline.org/cgi/reprint/165/2/254. Accessed April 28, 2010.
17. Kaskie B, Wallace N, Kang S, Bloom J. The implementation of managed behavioral healthcare in Colorado and the effects on older Medicaid beneficiaries. J Ment Health Policy Econ. 2006;9(1):15-24.
18. Burns BJ, Teagle SE, Schwartz M, Angold A, Holtzman A. Managed behavioral health care: a Medicaid carve-out for youth. Health Aff (Millwood). 1999;18(5):214-25. Available at: http://content.healthaffairs.org/cgi/reprint/ 18/5/214.pdf. Accessed May 13, 2010.
19. Raghavan R, Leibowitz AA, Andersen RM, Zima BT, Schuster MA, Landsverk J. Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system. Child Youth Serv Rev. 2006;28(12):1482-96. (Pubitemid 44597128)
20. Cook JA, Heflinger CA, Hoven CW, et al. A multi-site study of Medicaid-funded managed care versus fee-for-service plans' effects on mental health service utilization of children with severe emotional disturbance. J Behav Health Serv Res. 2004;31(4);384-402.
21. Leff HS, Wieman DA, McFarland BH, et al. Assessment of Medicaid managed behavioral health care for persons with serious mental illness. Psychiatr Serv. 2005;56(10):1245-53. Available at: http://ps.psychiatryonline. org/cgi/reprint/56/10/1245. Accessed March 21, 2010.
22. Soumerai SB, Ross-Degnan D, Avorn J, McLaughlin T, Choodnovskiy I. Effects of Medicaid drug-payment limits on admissions to hospitals and nursing homes. N Engl J Med. 1991;325(15):1072-77.
23. Soumerai SB, McLaughlin TJ, Ross-Degnan D, Casteris CS, Bollini P. Effects of a limit on Medicaid drug-reimbursement benefits on the use of psychotropic agents and acute mental health services by patients with schizophrenia. N Engl J Med. 1994;331(10):650-55. Available at: http://content.nejm.org/cgi/content/full/331/10/650. Accessed March 20, 2010. (Pubitemid 24276866)
24. Law MR, Ross-Degnan D, Soumerai SB. Effects of prior authorization of second-generation antipsychotic agents on pharmacy utilization and reimbursements. Psychiatr Serv. 2008;59(5):540-46. Available at: http://ps.psychiatryonline.org/cgi/reprint/59/5/540. Accessed March 21, 2010.
25. Soumerai SB, Zhang F, Ross-Degnan D, et al. Use of atypical antipsychotic drugs for schizophrenia in Maine Medicaid following a policy change. Health Aff (Millwood). 2008;27(3):185-95. (Pubitemid 351770278)
26. Zhang Y, Adams AS, Ross-Degnan D, Zhang F, Soumerai SB. Effects of prior authorization on medication discontinuation among Medicaid beneficiaries with bipolar disorder. Psychiatr Serv. 2009;60(4):520-27. Available at: http://ps.psychiatryonline.org/cgi/reprint/60/4/520. Accessed April 28, 2010.
27. Fischer MA, Avorn J. Economic consequences of underuse of generic drugs: evidence from Medicaid and implications for prescription drug benefit plans. Health Serv Res. 2003;38(4):1051-63. Available at: http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC1360932/pdf/hesr-162.pdf. Accessed May 13, 2010. (Pubitemid 37048299)
28. Office of Vermont Health Access, Agency of Human Services. Pharmacy best practices and cost control report 2009. Available at: http://ovha.vermont.gov/ for-providers/pharmacy-best-practices-and-cost-controlreport-2009.pdf. Accessed May 11, 2010.
29. Lieberman JA 3rd. Metabolic changes associated with antipsychotic use. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):8-13. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC487012/pdf/i1523-5998-6-s2-8.pdf. Accessed April 28, 2010.
30. Toalson P, Ahmed S, Hardy T, Kabinoff G. The metabolic syndrome in patients with severe mental illnesses. Prim Care Companion J Clin Psychiatry. 2004;6(4):152-58. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/ PMC514841/pdf/i1523-5998-6-4-152.pdf. Accessed April 28, 2010.
31. Mackin P, Bishop DR, Watkinson HM. A prospective study of monitoring practices for metabolic disease in antipsychotic-treated community psychiatric patients. BMC Psychiatry. 2007;7(28). Available at: http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC1913512/pdf/1471-244X-7-28.pdf. Accessed March 20, 2010. (Pubitemid 47055085)
32. Thomas MR, Waxmonsky JA, Gabow PA, Flanders-McGinnis G, Socherman R, Rost K. Prevalence of psychiatric disorders and costs of care among adult enrollees in a Medicaid HMO. Psychiatr Serv. 2005;56(11):1394-401. Available at: http://ps.psychiatryonline.org/cgi/reprint/56/11/1394. Accessed April 28, 2010. (Pubitemid 41579774)