Panel: Behavioral Health and Prescription Drug Utilization in the Medicaid Population

Saturday, November 9, 2019: 8:30 AM-10:00 AM
I.M Pei Tower: Majestic Level, Vail (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Organizer:  Shyam Raman, Indiana University
Panel Chair:  Laura Wherry, University of California, Los Angeles
Discussants:  Conor Lennon, University of Louisville and Aparna Soni, American University

This session discusses the impacts of increased health insurance coverage on health care and prescription drug utilization among Medicaid population.  Given the recent expansions in coverage and treatment options for the Medicaid population, the papers in this session provide necessary and timely insight on individuals’ responses to these new coverage options. This session engages diverse perspectives by using methods from marketing, public health, and economics to study the effects of public insurance expansions.

The session opens with a paper that investigates the effects of an optional Affordable Care Act (ACA)-facilitated state program Health Homes, which provides comprehensive and coordinated services for chronically-ill Medicaid enrollees. The study uses data on non-institutionalized Medicaid enrollees and finds increases in utilization of substance use disorder (SUD) treatment. The authors conclude that Medicaid Health Homes may be a promising model to address low use of SUD treatment among Medicaid enrollees.

The next two papers expand on the impact of insurance coverage on the market for prescription drugs. The first of these examines the effects of Medicaid expansions on prescription drug marketing by approaching supply-side responses to increased health care demand after the Affordable Care Act. Using linked data on drug marketing payments, the investigators study the impact of ACA-facilitated Medicaid expansions on promotions within this sample. The study finds that Medicaid expansions increase meal-based payments for low-priced drugs and non-meal detailing payments for high-priced drugs.

The cost of treating chronic disease has increased exponentially as more complex treatments become available. The third paper investigates the impact of Medicaid expansions on utilization of a preventative treatment for HIV (PrEP). The study uses state-level drug utilization data to estimate these effects, finding a significant increase in PrEP use and PrEP users – these effects are seen in a decrease in HIV diagnoses.  This paper provides insight into the efficacy and benefit of providing access, by way of insurance, to preventative measures against costly chronic disease.

With the issue of opioid misuse at the forefront of many discussions on prescription drug access and use, the necessity to evaluate the efficacy of prescription drug monitoring programs (PDMPs) is paramount. The final paper of this session examines the impact of PDMPs, both optional and must-access, on opioid prescriptions in the Medicare, Medicaid, and employer sponsored insurance populations. The study finds effects of PDMP implementation in the Medicare and Medicaid populations, but no strong effects in the employer sponsored market.

The four papers comprise a broad perspective of the impacts of insurance coverage, prescription drug utilization, and supply-side responses to health care demand. The lessons taken from these papers could help policy-makers understand the impacts of increased insurance access on health care and drug utilization, expand on the role of drug marketing after coverage expansions, and better validate the salience of prescription drug monitoring programs among publicly insured populations.

The Effect of Medicaid Health Homes on Individuals with Behavioral Health Disorders
Chandler McClellan1, Catherine Maclean2, Brendan Saloner3, Beth McGinty3 and Michael F. Pesko4, (1)Substance Abuse and Mental Health Services Administration, (2)Temple University, (3)Johns Hopkins University, (4)Georgia State University

Does Expansion of Public Health Insurance Affect Prescription Drug Marketing?
Thuy Nguyen1, W. David Bradford2, Rena Conti3 and Kosali Simon1, (1)Indiana University, (2)University of Georgia, (3)University of Chicago

Does Providing Insurance Coverage Reduce the Spread of Infectious Disease? the Impact of Medicaid Expansions on HIV Diagnoses.
Alex Hollingsworth1, Shyam Raman1, Dan Sacks1 and Katherine Wen2, (1)Indiana University, (2)Cornell University

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