Access and Utilization of New Antidepressant and Antipsychotic Medications. Patterns of Antipsychotic Utilization in High-Volume States

01/01/2000

Recognizing that national data may not be reflective of trends in individual States, utilization trends for 12 high-volume States (in number of prescriptions) in 1998 were analyzed in greater detail. The States included in this analysis were: California, Florida, Georgia, Illinois, Maryland, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, and Wisconsin, all of which are among those with the highest utilization and among those interviewed for the present study. (Texas, a state with a large Medicaid population and an interview subject for this study, is excluded because Texas Medicaid reported no pharmaceutical utilization data to HCFA(now known as CMS) in 1998.)

Exhibit VI-9 reports the volume of antipsychotic medications paid for under Medicaid in these twelve high-volume States, which account for 64% of prescription volume for antipsychotics reported by Medicaid programs in 1998. Moreover, the 12 States account for 67% of the total amount reimbursed for antipsychotics in 1998.

Exhibit VI-9. Number of Antipsychotic Prescriptions and Total Amount of Medicaid Reimbursement for 12 High-Volume Prescription States, 1998

  Prescriptions Expenditures
State Number
(Thousands)
% of Medicaid
Antipsychotic Rx's
$ Amount
(Millions)
% of Medicaid
Antipsychotic $
CA 1,401 13% $191 16%
NY 1,261 11% $150 12%
IL 582 5% $69 6%
OH 646 6% $68 6%
FL 540 5% $65 5%
MA 557 5% $64 5%
PA 548 5% $55 4%
NJ 372 3% $38 3%
MI 330 3% $38 3%
WI 304 3% $34 3%
GA 300 3% $27 2%
MD 195 2% $16 1%
12-State Total 7,036 64% $815 67%
US Total 10,992 100% $1,219 100%

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


Exhibit VI-10 depicts the share of total antipsychotic utilization in each state for five categories of antipsychotics: clozapine, risperidone, olanzapine, oral haloperidol, phenothiazines, and quetiapine. In interpreting these data, it should be remembered that phenothiazine prescriptions might reflect use for other disorders.

Exhibit VI-10.Market Share of Antipsychotics in 12 High-Volume Medicaid States as a Percent of Total Antipsychotic Prescriptions, 1998

State Clozapine Haloperidol Olanzapine Phenothiazines Quetiapine Risperidone
CA 4% 17% 20% 31% 1% 19%
NY 3% 13% 20% 29% 1% 28%
IL 7% 15% 18% 24% 3% 27%
OH 4% 14% 21% 27% 2% 25%
FL 3% 12% 19% 28% 2% 29%
MA 6% 12% 26% 24% 2% 26%
PA 4% 14% 19% 24% 1% 30%
NJ 4% 14% 18% 30% 0% 28%
MI 7% 15% 19% 24% 2% 27%
WI 6% 14% 19% 24% 2% 24%
GA 2% 18% 14% 34% 1% 21%
MD 3% 16% 22% 25% 0% 28%

Source: Lewin Group Analysis of HCFA(now known as CMS) Medicaid Drug Rebate Program Data, 1998. The columns do not add to 100%. Data for the "Other Antipsychotics" category are excluded in the interest of space and clarity.


The data in Exhibit VI-10 show:

  • Phenothiazines were the most frequently prescribed antipsychotic in 5 States (California, Georgia, New Jersey, New York, Ohio).
    • Phenothiazines accounted for between 24% (several States) and 31% (CA) of prescriptions.
  • Risperidone was the most frequently prescribed antipsychotic in 6 other States (Florida, Illinois, Massachusetts, Maryland, Michigan, Pennsylvania).
    • Risperidone accounted for between 19% (CA) and 30% (PA) of total scripts.
    • Medi-Cal lagged the rest of its peers in adoption of risperidone.
  • In Wisconsin, there were roughly equal numbers of prescriptions for phenothiazines and risperidone in 1998.
  • Olanzapine ranked third in total prescriptions in every state except for California, Massachusetts and Georgia. The share of prescriptions accounted for by olanzapine ranged from 14% (Georgia) to 26% (Massachusetts).
    • Olanzapine prescriptions outnumbered risperidone prescriptions in Medi-Cal in 1998 by 15,000.
    • In Massachusetts, olanzapine prescriptions equaled those for risperidone with 26% of the total each.
    • In Georgia olanzapine ranked fourth with only 14% share.
  • Haloperidol ranked fourth in every state except Georgia, capturing between 14% and 19% of to prescriptions.
  • Clozapine, generally reserved for treatment-refractory cases of schizophrenia, accounted for between 2% (Georgia) and 7% (Illinois, Michigan) of total antipsychotic prescriptions.
  • Quetiapine gained no more than 3% market share in any state.