Evidence-Based Practices for Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder. B. Pharmacologic EBPs for Bipolar Disorder


Table A.5 summarizes the approaches used to measure the receipt of evidence-based medications and medication continuity for bipolar disorder.

TABLE A.5. Measurement of Medication Use and Continuity for Bipolar Disorder

EBP for Bipolar Disorder



* Carbamazepine, valproate, and lamotrigine were the only anticonvulsants considered evidence-based.
Use of medication Beneficiaries with at least one claim for lithium, anticonvulsant,* or antipsychotic Beneficiaries diagnosed with bipolar disorder
Continuity of medication Number of beneficiaries for whom the total days’ supply on all nonoverlapping lithium, anticonvulsant,* or antipsychotic fills was 80 percent or more of the days since their first fill for one of those medications Number of beneficiaries whose first prescription fill for lithium, an anticonvulsant,* or an antipsychotic was more than 90 days away from the end of the study period (December 31, 2007) or their disenrollment from Medicaid
Use of antidepressants At least 60 consecutive days of antidepressant use without concurrent claim of lithium, anticonvulsant,* or antipsychotic Beneficiaries with any bipolar disorder diagnosis and at least 90 days consecutive days of antidepressant use

We measured medication continuity among beneficiaries diagnosed with bipolar disorder following the same approach to medication continuity among beneficiaries with schizophrenia. However, for beneficiaries with bipolar disorder, the numerator for medication continuity included lithium, anticonvulsants, or antipsychotics, but the beneficiary was not required to remain on only one of these medications to be counted as receiving continuous medications. For example, an individual switching from lithium to an anticonvulsant but without a break in filled prescription days would be counted as receiving continuous medications. We used this strategy in recognition of the cyclical and evolving nature of bipolar disorder.

As an indicator of care inconsistent with EBPs, we also measured if a beneficiary diagnosed with bipolar disorder received an antidepressant for at least 60 days without a concurrent “mood stabilizer,” including lithium, anticonvulsants (carbamazepine, valproate, and lamotrigine), or any antipsychotic.

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