Medicaid Pharmacy Outcome Analysis

Kentucky’s Medicaid program has one of the highest utilization rates for prescription drugs in the nation, with rates for some high-cost medication classes ranked in the top 5 among all states. In addition, the Kentucky Medicaid pharmacy program is one of the most costly components of member benefits. Anti-psychotic drugs are the most expensive class of Medicaid pharmaceuticals. Kentucky spends nearly $100 million on anti-psychotic drugs annually. While the new generation of atypical antipsychotic medications provides remarkable breakthrough care for some patients with schizophrenia and bipolar mania, it is subject to “off-label” use, inappropriate dosing, and poly-pharmacy. Such inappropriate prescribing does not follow evidence-based medicine and may be dangerous to some patients. In financial terms, in Kentucky’s Medicaid program, approximately one-third of antipsychotic drug usage appears to differ from established evidence-based practice, offering the potential for saving Kentucky approximately $30 million annually.

To address this problem, Medicaid Pharmacy Analysis and Recommendation, led by Jeffrey Talbert in the UK College of Pharmacy, is working to improve or maintain Kentucky Medicaid patient outcomes and satisfaction for those using this class of drugs while significantly reducing pharmaceutical costs to the Commonwealth.

The project has the potential to save Kentucky millions of dollars per year in Medicaid costs. It uses a software program, ArtemetRX, developed by a former UK pharmacy professor, to analyze usage of prescribed pharmaceuticals by Medicaid recipients.

Actions and Outcomes to Date

Working statewide with the Kentucky Department for Medicaid Services, Dr. Talbert has completed an analysis of the cost and outcomes for Kentucky Medicaid patients using different pharmaceuticals in this drug class. He has determined that no one product is superior for all patients in terms of effectiveness or side effects, making cost effectiveness perhaps the main factor in formulary decisions. Dr. Talbert has also found repeatedly that inefficient utilization is occurring. On that basis, at his recommendation, the Kentucky Department for Medicaid Services has hired a disease management company, Comprehensive Neuroscience, to reduce inappropriate usage. Talbert continues to monitor the outcomes and provide an independent evaluation of how well the program corrects the problems. The results of this evaluation will be used by the Kentucky Medicaid program to update formulary decisions and restrictions on uses of this antipsychotic drug class.