Insomnia is a common symptom in individuals with mental illness (MI), including depression, anxiety disorders, attention deficit hyperactivity disorder (ADHD) and schizophrenia;insomnia affects both functioning and mental health treatment outcomes.1-4 Effective treatment of insomnia has been shown to positively impact treatment outcomes, health and quality of life in this population.2, 4-7 State Medicaid Directors identify the utilization of insomnia drugs as a critical issue needing evaluation because of concerns about expenditures and substitution to low-dose atypical antipsychotics after they implement access policies directed at sedative hypnotics.8 We will develop a pooled multi-state Medicaid dataset to study changes in health service utilization (including psychotropic medication utilization) associated with psychotropic prescription access policy implementation. We will initially use this database to study prescription and non-prescription utilization by individuals with MI prescribed sedative hypnotic prescription drugs. We will conduct a pre/post-implementation policy analyses of utilization trends within the collaborating states of Colorado, Oregon and Kansas, comparing the impact of three sedative hypnotic access restriction policies (preferred drug lists, prior authorization and cost sharing). Each state's analysis cohort is all people with an MI diagnosis. Diagnosis-specific subgroups for sub-analyses are people with depression, anxiety disorders, ADHD and schizophrenia. We will quantify the effect of policy implementation on medication and service utilization, substitution and expenditures in the total cohort and the diagnosis-specific subgroups. Specific Aim 1: Among Medicaid beneficiaries with a mental illness, compare utilization trends of newer sedative hypnotics, alone and in combination with other psychotropics, across three state Medicaid programs from 2002-2007. Specific Aim 2: Examine the effects of prescription access policies on the utilization of newer sedative hypnotics, pre-to-post policy implementation in each state, and potential substitutions to other psychotropic drugs such as low dose atypical antipsychotics. Specific Aim 3: Compare the impact of implementing prescription access restriction policies on overall prescription drug expenditures and service utilization expenditures among Medicaid beneficiaries with a mental health diagnosis, pre- and post-policy implementation.

PUBLIC HEALTH RELEVANCE: We will develop a pooled multistate Medicaid dataset in order to study health care utilization changes associated with psychotropic drug access policy design, implementation and utilization in Colorado, Kansas and Oregon. We will initially use this database to study prescription drug and service utilization of individuals with mental illness that take sedative hypnotic prescription drugs. Research on the impact of prescription access restrictions on the utilization of prescription and non-prescription services, and overall healthcare expenditures, will permit Medicaid programs to refine prescription benefit design, as well as implement psychotropic prescription access policies that optimize health status and maximize the yield of each health care dollar.

R01MH086310

2009-07-01

2013-12-31