Objectives: Switches from Commercial to Medicaid insurance may impact patient access and healthcare resource use. We descriptively assessed payor switch rate, HCRU, and costs by race for patients with schizophrenia.
Methods: STATinMED RWD Insights (all-payer medical + pharmacy claims dataset) was used to assess patients aged ≥18 years with ≥1 inpatient or ≥2 outpatient claims for schizophrenia (ICD-9-CM:295.0x-295.9x excluding 295.7x [schizoaffective disorder]; ICD-10-CM:F20.XX) in identification period (01JAN2015-30JUN2020; earliest claim date=initial diagnosis date [IDD]), antipsychotic use after IDD, enrolled in commercial plan on IDD, 12-month continuous enrollment pre- and post-IDD, and race. Patients with Medicare FFS/Advantage coverage in study period excluded; switchers had insurance payor change to Medicaid after IDD (first Medicaid claim=index date) and 12-month enrollment pre- and post-switch.
Results: Of 18,392 patients, mean age=41 (standard deviation [SD]=13), men=52%, White=72%, Black=25%, and Asian=3%. Of those, 63% switched from commercial to Medicaid; mean age=40 (SD=12). Of Black patients with schizophrenia, 74% switched coverage vs White (63%) and Asian patients (51%). Mean household income among switchers was $27,655 (SD=$35,688) for Black, $35,912 (SD=$41,146) for White and $43,538 (SD=$37,853) for Asian patients. After commercial-to-Medicaid switch, all-cause inpatient stays increased for all groups; highest changes observed: Black (pre-switch=57% vs post-switch=66%; %Diff=9%), White (55% vs 61%; %Diff=6%), and Asian patients (46% vs 51%; %Diff=5%). Pharmacy visits were highest for Asian (17.7 vs 19.4; Diff=1.7) vs White (22.5 vs 24.0; Diff=1.5) and Black patients (17.7 vs 18.1; Diff=0.4). Total mean costs decreased for White ($17,848 vs $17,596) and Black patients ($15,754 vs $15,511) and increased for Asian patients ($12,578 vs $14,164) pre- and post-switch.
Conclusions: Black patients with schizophrenia were significantly more likely to switch to Medicaid vs other groups. Total costs were flat post-switch for Black and White patients and increased for Asians despite lower reimbursement rates. Despite coverage switches with favorable cost sharing, medication use among Black patients declined and hospitalization increased.