Continued Low Rate of Clozapine Use and Wide Variability Found in State Medicaid Programs

Clozapine continues to be dramatically underutilized—despite it being the only drug approved for treatment-resistant schizophrenia—and there appears to be significant variation among states in its use for patients in the Medicaid program.

That’s the finding from an analysis of Medicaid data in 46 states published Monday in Psychiatric Services in Advance. Mark Olfson, M.D., M.P.H. (pictured left), of Columbia University and colleagues updated a previous analysis from 2001 to 2005 to include data from 2006 to 2009.

Overall, clozapine accounted for 4.8% of antipsychotic use in schizophrenia from 2006 to 2009, with a slight decline during this period (5.7% in 2006 to 4.3% in 2009). Clozapine was least commonly used in the Deep South (Louisiana, Mississippi, and Alabama) and more commonly used in New England, the Rocky Mountain West, and Washington. The highest rate of clozapine prescribing was in South Dakota (15.6%) and the lowest was in Louisiana (2.0%).

The authors of the analysis noted several factors associated with low clozapine use: fiscal stress, inadequate staffing to monitor clozapine, patient reluctance about blood monitoring, and concerns over tolerability.

Recently, the Food and Drug Administration issued modifications to its requirements for blood monitoring for patients receiving clozapine in an effort to lessen the burden on clinicians and patients. “I think the new monitoring system will be quite helpful,” Olfson said in comments to Psychiatric News. “It simplifies the clinical evaluation of neutropenic events, increases access to clozapine for patients with benign neutropenia, and permits those who develop mild neutropenia to continue treatment.”

For related information, see the Psychiatric News article “Why Won’t Clinicians Use Clozapine Despite Proven Superiority?”