Eric Slade, Ph.D., of the University of Maryland School of Medicine and Linda Simoni-Wastila, Ph.D., B.S.Pharm., of the University of Maryland School of Pharmacy developed forecasts of expenditures on antipsychotics in calendar years 2016 and 2019 by looking at the estimated percentage reduction in Medicaid expenditures for risperidone from 2008 to 2011, when that drug was the only second-generation antipsychotic available generically. They used state-level aggregate data on outpatient antipsychotic prescriptions from 2008 to 2011 drawn from the Medicaid state drug utilization database.
The researchers estimate that annual Medicaid expenditures for antipsychotics will decrease by $1,794 million (48.8 percent) by 2016 and by $2,814 million (76.5 percent) by 2019. Adjustment for variable prices of branded medications and changes in Medicaid enrollment only moderately affected the magnitude of these reductions, they say.
“Anticipated reductions in spending on antipsychotics should be factored into reassessments of the ongoing need for Medicaid formulary restrictions on second-generation antipsychotics,” the researchers state. “…[R]apid increases in antipsychotic expenditures following the introduction of branded second-generation antipsychotic medications in the 1990s led some states to impose formulary restrictions on access to these medications in Medicaid. However, at best, these policies result in little or no net savings to Medicaid and, at worst, adversely affect patients’ medication access and outcomes. Consequently, if Medicaid is entering a period of rapidly decreasing antipsychotic expenditures, states’ original rationale for formulary restrictions may be significantly eroded.”
For more on Medicaid formulary restrictions, see the Psychiatric News article, “When Medication Barriers Go Up, Adverse Events May Follow.”