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Restrictive Prescription Drug Policies Hurt Schizophrenics

Tuesday, April 1, 2008 12:00 AM

TUESDAY, April 1 (HealthDay News) -- Restrictive prescription drug policies can cause schizophrenia patients to stop taking their medications, a Harvard Medical School study suggests.

Researchers looked at Medicare beneficiaries with schizophrenia in Maine before, during and after a policy that required patients to use an authorized medication (step treatment) before they were permitted to be prescribed drugs not on the preferred list. They were compared to Medicare beneficiaries with schizophrenia in New Hampshire, where there was no such regulation.

The study found that the Maine patients were 29 percent more likely to stop or disrupt medication when subject to the tightened policy. In addition, the restrictive drug policy -- originally designed to reduce costs -- provided only minimal savings.

After less than one year, the Maine policy was replaced by a provider education program, noted the authors of the study, which was published online April 1 in the journalHealth Affairs.

"This study calls into question the effectiveness of many similar policies throughout the country," study senior author Stephen Soumerai, a professor at Harvard Medical School, said in a prepared statement. "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."

As their medication choices are restricted, more patients discontinue treatment, Soumerai noted.

Previous research has found that interruptions in taking antipsychotic medications are likely to lead to recurrence of psychotic episodes and higher hospitalization rates and costs for patients.

Schizophrenia affects 1 percent of the U.S. population, or about 3 million people. Without antipsychotic medication, about 80 percent of patients will suffer a serious recurrence of their illness within a year, according to background information in the study.

While prior authorization and step treatment policies may be appropriate for some types of medications, such policies put patients with chronic mental illness at particular risk, the study authors said.

"Given the tremendous variation in individual responses to 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," Soumerai said. "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."

More information

Mental Health America has more about schizophrenia.

SOURCE: Harvard Medical School, news release, April 1, 2008

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