Restrictive drug policies often cause schizophrenic patients to discontinue medication

April 1, 2008

Policies requiring authorization before physicians can prescribe newer medications to schizophrenic patients may be counter-productive. According to a new study, patients in Maine’s Medicaid program who found themselves in this situation were 29% more likely to stop or disrupt medication use than patients not subject to the policy. In addition, although the policy was originally designed to cut costs, government savings were minimal at best. These findings are reported online in Health Affairs.

The study, led by investigators from Harvard Medical School’s Department of Ambulatory Care and Prevention, looked at Maine Medicaid beneficiaries with schizophrenia on antipsychotic drugs before, during, and after a policy that required patients to use an authorized medication (step treatment) before they were allowed to use drugs not on the preferred list. They were compared to similar beneficiaries in New Hampshire, where there was no prior authorization regulation. The Maine policy was replaced by a provider education program after less than a year.

Study data indicated that the original Maine policy disrupted essential antipsychotic treatment for vulnerable patients with schizophrenia, with minimal or no cost savings.

“This study calls into question the effectiveness of many similar policies throughout the country,” says Stephen Soumerai, Harvard Medical School professor and senior author on the study. “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.” However, as medication choice is restricted, more patients discontinue treatment.

Previous studies have shown that gaps in antipsychotic medication use are likely to result in recurrence of psychotic episodes and higher hospitalization rates and costs for these patients.

Schizophrenia is a disabling and costly illness that afflicts approximately one percent of the US population, or three million people. Without antipsychotic treatment, about 80% of patients will have a serious recurrence of their illness within a year. The study investigators believe that while there is a legitimate place for prior authorization and step treatment policies for some medications, patients with chronic mental illness are put at particular risk of receiving inadequate treatment.

“Given the tremendous variation in individual responses to these drugs as well as the devastating impact of treatment disruptions on schizophrenic patients, a policy that pushes all patients toward a limited number of preferred drugs may do more harm than good,” says Dr. Soumerai. “It would be much better to focus on ensuring that antipsychotic drugs are prescribed for evidence-based reasons and that preferred drugs are prescribed only to patients who can benefit from them.”

Source: Harvard Medical School

Explore further: Breathing exercises help asthma patients with quality of life

Related Stories

Breathing exercises help asthma patients with quality of life

December 13, 2017
A study led by the University of Southampton has found that people who continue to get problems from their asthma, despite receiving standard treatment, experience an improved quality of life when they are taught breathing ...

Managing concerning behaviors when opioids are taken for chronic pain

December 11, 2017
Patients receiving long-term opioid therapy for chronic pain sometimes demonstrate challenging and concerning behaviors, such as using more opioid medication than prescribed or concomitant alcohol or drug use. A new study, ...

How to regulate fecal microbiota transplants

December 15, 2017
(Medical Xpress)—A small team of researchers at the University of Maryland, some with affiliations to the Veterans Affairs Maryland Health Care System, has written and published a Policy Forum piece in the journal Science ...

Making medicines affordable: New report calls for government negotiation of drug prices

November 30, 2017
Consumer access to effective and affordable medicines is an imperative for public health, social equity, and economic development, but this need is not being served adequately by the biopharmaceutical sector, says a new report ...

Tackling the high cost of prescription drugs

December 4, 2017
The high cost of prescription drugs in the United States came under scrutiny in a new report from the National Academies of Sciences, Engineering, and Medicines, "Making Medicines Affordable: A National Imperative," co-authored ...

For opiate addiction, study finds drug-assisted treatment is more effective than detox

November 23, 2017
Say you're a publicly insured Californian with an addiction to heroin, fentanyl or prescription narcotics, and you want to quit.

Recommended for you

Drug for spinal muscular atrophy prompts ethical dilemmas, bioethicists say

December 11, 2017
When the Food and Drug Administration approved the first drug for people with spinal muscular atrophy a year ago, clinicians finally had hope for improving the lives of patients with the rare debilitating muscular disease. ...

FDA's program to speed up drug approval shaved nearly a year off the process

December 7, 2017
Speeding the pace at which potentially lifesaving drugs are brought to market was a rallying cry for Donald Trump as a candidate, and is a stated priority of his Food and Drug Administration commissioner, Dr. Scott Gottlieb. ...

Dangers of commonly prescribed painkillers highlighted in study

December 6, 2017
Commonly prescribed painkillers need to be given for shorter periods of time to reduce the risk of obesity and sleep deprivation, a new study has revealed.

Viagra goes generic: Pfizer to launch own little white pill

December 6, 2017
The little blue pill that's helped millions of men in the bedroom is turning white. Drugmaker Pfizer is launching its own cheaper generic version of Viagra rather than lose most sales when the impotence pill gets its first ...

Surgery-related opioid doses can drop dramatically without affecting patients' pain

December 6, 2017
Some surgeons might be able to prescribe a third of opioid painkiller pills that they currently give patients, and not affect their level of post-surgery pain control, a new study suggests.

Four-fold jump in deaths in opioid-driven hospitalizations

December 4, 2017
People who end up in the hospital due to an opioid-related condition are four times more likely to die now than they were in 2000, according to research led by Harvard Medical School and published in the December issue of ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.