Abstracts

Rationale:
Medicaid is a joint federal-state program that provides healthcare coverage to an estimated 72.4 million people in the US. Each state designs and administers their own Medicaid program including how they deliver and pay for care for Medicaid beneficiaries.  Over the past decade, states have increasingly contracted with managed care organizations (MCOs) to provide for the delivery of Medicaid health benefits, including pharmacy benefits, rather than having fee-for-service (FFS) programs. The intent of Medicaid managed care is to reduce program costs and improve healthcare quality including access to care, especially for chronic and complex conditions.  Epilepsy is a life-long chronic condition that requires complex care.  Access to antiseizure medications (ASMs) is an integral part of this care.  Little is known about access to ASMs in the setting of Medicaid managed care.  The objective of our study was to examine differences across states in the percent of the Medicaid population covered by managed care and to describe state-specific Medicaid ASM formulary coverage in relationship to this Medicaid managed care setting.
Method:
The percentage of each state or district’s Medicaid population covered by MCOs was extracted from macpac.gov. Next, data regarding ASM formulary coverage was retrieved from each state’s Medicaid website.  Linear regression was performed to model the relationships between percent of Medicaid population covered by MCOs and specific trends in ASM formulary coverage including number of ASMs included on the Medicaid formulary, number of ASMs requiring prior authorization, and number of non-formulary ASMs.
Results:
Percentage of Medicaid population covered by MCOs and Medicaid ASM formulary coverage was identified for 26 states.  Regression analyses indicate that there is a positive relationship between the percentage of a state’s Medicaid population covered by MCOs and the number of ASMs designated as formulary in that state (p = 0.029; r = 0.43). The regression also indicates that there is a negative relationship between the percentage of a state’s Medicaid population covered by MCOs and the number of ASMs that require prior authorization in that state (p = 0.008; r = -0.15). No association was identified between the percentage of a state’s Medicaid population covered by MCOs and number of non-formulary ASMs.
Conclusion:
The prevalence of Medicaid managed care has increased over the past decade.  Little is known about how this might impact Medicaid ASM formulary coverage trends.  Our study suggests that the relationship is complex as states with a high percentage of Medicaid patients enrolled in MCOs which are meant to reduce cost and optimize value seem to also have formularies that cover a greater number of ASMs, and have less ASMs that require prior authorizations.  The impact of Medicaid managed care on access to ASMs across states merits further study.
Funding:
:There was no funding that was received in support of this abstract