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Restrictive Drug Policies Could Lead Schizophrenics to Stop their Medications
> 4/28/2008 12:04:37 PM

Policies that require physicians to gain authorization from insurance companies before prescribing certain specialty medications to Medicaid recipients may put patients at risk for poor health outcomes, according to research from the April issue of Health Affairs. Prior authorization policies are money-saving strategies enacted by insurance companies that require physicians to report to them before prescribing certain expensive anti-psychotic drugs so that the companies can delay decisions and keep the overall prescription numbers down. Some require that a patient fail to acheive desired results on at least one alternate medication before authorizing the prescription of the drug chosen by the physician. By examining Medicaid data on Maine residents, a team of researchers found that when a prior authorization policy was in place, individuals with schizophrenia were more likely to discontinue their medication.

The researchers, led by Dr. Stephen Soumerai of Harvard Medical School, studied patients with schizophrenia who were prescribed an antipsychotic medication before, during, and after the time in which Maine's prior authorization policy, which lasted less than a year, was in effect. They compared this information with data from a similar group of patients in New Hampshire, where no such policies existed. When Maine's prior authorization policy was in place, patients taking atypical antipsychotics had a 29 percent greater chance of discontinuing their medication than patients taking these medications before the policy was established. Additionally, the researchers observed no change in discontinuation rates in New Hampshire during this time.

These policies were designed in part to reduce the costs of health care by requiring physicians to seek permission before prescribing medications not on a preferred list. In a press release, Dr. Soumerai discussed how this restrictive process could affect a doctor's prescribing practices and influence a patient's behavior: "Getting prior authorization requires paperwork and is time-consuming, so physicians may tend to switch to prescribing preferred medications even if they have concerns about the appropriateness of the medication for a specific patient."

Despite the policy's original purpose, the researchers noted only a small decrease in costs as a result of the policy. More importantly, they stress that the observed increase in discontinuation rates could lead to potentially devastating consequences for many individuals. Previous research has shown that when someone with schizophrenia stops taking their medication, they are more likely to relapse and require hospitalization. Further examination is needed, as the researchers of this current study did not look at hospitalizations or other measures of well-being among the Maine subjects. Future studies may show that the increase in discontinuation did indeed lead to an increase in hospitalizations, clarifying the prior authorization policy's specific effects on health outcomes.

Many people with schizophrenia stop taking their medication for various reasons ranging from the unpleasant side effects of antipsychotic drugs to the belief that they are not really sick. The response an individual will have to the different medications used to treat schizophrenia varies, and prior authorization policies place barriers between patients and the medications that will be most effective for them. While researchers note that these policies are appropriate in some situations and in regards to some medications, they maintain that change is needed. These policies can limit the options of individuals with serious mental illnesses, and by ensuring the availability of different potential treatments, we can help them to receive treatment they will find most beneficial.

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