Patient access and healthcare resource use (HCRU) can be impacted by switches from Commercial to Medicaid insurance.  


Descriptively assess payor switch rate, HCRU, and costs by race for patients with schizophrenia 


STATinMED RWD Insights (all-payer medical and pharmacy claims dataset) was used to assess patients aged ≥18 years with ≥1 inpatient or ≥2 outpatient diagnosis 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 an insurance payor change to Medicaid after IDD (first Medicaid claim=index date) and 12-month enrollment pre- and post-switch. 


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.  


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. 

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