Access problems for psychiatric patients to Medicaid medication leads to increased hospital, emergency care

Too often, mental health patients have problems accessing or paying for their prescription drugs under Medicaid. The results — longer hospital stays and more emergency room visits — are hard on patients and costly for the entire health care system, a new study finds.

Lead author Joyce West, Ph.D., and colleagues analyzed Medicaid data from 10 states and found that psychiatric patients who reported access problems with their medication visited the emergency department 74 percent more often than those who had no such difficulties.

Of the 1,625 patients West and colleagues tracked, almost a third could not access the clinically indicated or preferred medication because Medicaid did not approve it. Patients with medication access issues experienced 72 percent more acute hospital stays compared to patients without access problems.

Access problems included prescribed medication being discontinued, temporarily stopped or not covered. Some patients had problems making the co-payment.

"What's particularly troubling is that it can often take several trials and many months, if not longer, to find an appropriate medication regimen that a patient responds to," said West, policy research director at the American Psychiatric Institute for Research and Education and an assistant professor of mental health at Johns Hopkins University.

The study appears in the November-December issue of the journal General Hospital Psychiatry.

"There are major clinical risks to psychiatric patients when they're stable on their medication and then switch to a different medication," West said. "Policies to facilitate medication continuity are critically important for this highly vulnerable population."

Policymakers can save money in the Medicaid program by clamping down on medication, but other areas including emergency room visits will undeniably increase, said Ken Duckworth, medical director for the National Alliance on Mental Illness and assistant professor at Harvard Medical School.

"It's another piece in a body of evidence that says what you're doing when you're restricting access to psychiatric drugs is squeezing the balloon," Duckworth said. Psychiatric hospitalization costs $800 to $1,000 a day. "So it is quite expensive for the system," Duckworth said.

Duckworth said incarceration it particularly is important for patients with conditions such as schizophrenia, bipolar disorder and borderline personality disorder to take medications consistently.