Access and Utilization of New Antidepressant and Antipsychotic Medications. In 1998, 51% of All Medicaid Prescriptions for Antipsychotics were for Atypical Antipsychotics. Expenditures on Atypicals Accounted for 89% of Total Spending on Antipsychotics

01/01/2000

  1. In 1998, Medicaid programs in the 45 States analyzed paid for nearly 11 million prescriptions for antipsychotics. Exhibit VI-2 shows the market share in Medicaid for each class of antipsychotic in 1998. Phenothiazines accounted for the largest share of antipsychotic prescriptions, with approximately 3.0 million prescriptions, or a 26% share. Risperidone ranked second in number of prescriptions (2.8 million, 25%) followed by olanzapine (2.2 million, 20%), and haloperidol (1.6 million, 15%). Clozapine prescriptions accounted for 4% of total prescriptions (442,000 prescriptions). Quetiapine logged only 174,000 prescriptions in its first full year on the market (2%), slightly less than the number of prescriptions for injectable haloperidol (185,666, 2% share). As a group, atypical antipsychotics accounted for just over 53% of all prescriptions for antipsychotics in 1998 (4.6 million).

Exhibit VI-1. Antipsychotic Categories

Class Grouping Trade Names and Examples
Risperidone Risperdal®
Olanzapine Zyprexa®
Quetiapine Seroquel®
Clozapine Clozaril® 
Generics (from 1998)
Haloperidol Haldol® 
Generics
Injectable Haloperidol Haldol® decanoate
Phenothiazines Chlorpromazine (Thorazine®)
Fluphenazine (Prolixin®)
Perphenazine (Trilafon®)
Thioridazine (Mellaril®)
Other Phenothiazines
Others Loxapine (Loxitane®)
Molindone (Moban®)
Pimozide (Orap®)
Thiothixene (Navane®)
Others

In dollar terms, these 11 million prescriptions corresponded to expenditures of $1.3 billion. As seen in Exhibit VI-3, olanzapine accounted for the largest share of spending for antipsychotics at $536 million (42%). Risperidone ranked second at $395 million (31%), followed by clozapine at $172 million (14%). Oral haloperidol and phenothiazines accounted for only 2% ($12.3 million) and 6% ($75.6 million) of expenditures, respectively. Quetiapine accounted for 2% of total antipsychotic expenditures ($24 million). Atypical antipsychotics account for the vast majority of expenditures on antipsychotics: in 1998, just over $1.1 billion, or 89% of expenditures.

Oral formulations comprise the vast majority of the outpatient Medicaid market. Injectable haloperidol accounted for 2% of prescriptions (185,666) and 2% of expenditures ($27.6 million) in 1998.

Exhibit VI-4 presents the data in Exhibits VI-2 and VI-3 in tabular format.

Exhibit VI-2. Market Share of Antipsychotic Classes in 45 Medicaid States, 1998. Total Prescriptions = 11 Million

Exhibit VI-2. Market Share of Antipsychotic Classes in 45 Medicaid States, 1998. Total Prescriptions = 11 Million

Source: The Lewin Group analysis of HCFA(now known as CMS) Medicaid Drug Rebate Program Data, 1998. 45 States Reporting.

Exhibit VI-3. Market Share of Antipsychotic Classes in 45 Medicaid States, 1998. Total Expenditures = $1.3 Billion

Exhibit VI-3. Market Share of Antipsychotic Classes in 45 Medicaid States, 1998. Total Expenditures = $1.3 Billion

Source: The Lewin Group analysis of HCFA(now known as CMS) Medicaid Drug Rebate Program Data, 1998. 45 States Reporting.

Exhibit VI-4. Share of Medicaid Antipsychotic Prescriptions and Expenditures by Class, 1998

  Prescriptions Expenditures
Class Number
(000s)
% of Medicaid
Antipsychotic Rx
Cost
(Millions)
% of Medicaid
Antipsychotics $
Clozapine 443 4% $172 14%
Risperidone 2,803 26% $395 31%
Olanzapine 2,176 20% $536 42%
Quetiapine 174 2% $24 2%
Haloperidol 1,610 15% $12 1%
Injectable Haloperidol 186 2% $28 2%
Phenothiazines 2,985 27% $76 6%
Other Antipsychotics 615 6% $21 2%
All Antipsychotics 10,992 100% $1,265 100%

Source: The Lewin Group analysis of HCFA(now known as CMS) Medicaid Drug Rebate Program Data, 1998. 45 States Reporting.