BACKGROUND

Outpatient care utilization decreased dramatically following the COVID-19 pandemic but less is known about changes in medication use.

OBJECTIVES

To estimate changes in antipsychotic medication use, overall and by policies restricting LAI administration by pharmacists, in the first four months of the pandemic.

METHODS

A cross-sectional study of claims, from Decision Resources Group, was conducted among 578,011 schizophrenia patients. Percent change in medication use from 17 weeks prior to (pre-pandemic) and following (pandemic) 3/2/2020 were calculated. Antipsychotic use was categorized by administration route, channel, amount, and by state regulations authorizing pharmacist LAI administration: “authorized”, authorized with collaborative practice agreement (“CPA”), and not authorized (“restricted”). Comparisons were made among Medicaid, Medicare, and commercially-insured populations.

RESULTS

Among the Medicaid, Medicare, and commercially-insured populations, days’ supply for oral antipsychotics increased by 1.4%, 1.8%, and 4.3%. Retail-dispensed oral antipsychotics increased 0.9% among commercially-insured and decreased 1.4% and 2.3% for Medicaid and Medicare, while mail order prescriptions increased by 16.7% (commercial), 29.6% (Medicaid), and 32.5% (Medicare).

In contrast, LAI claims decreased by 1.5%, 2.5%, and 4.8%. Approximately 60% of all LAIs were dispensed in authorized states, compared to 25% in CPA and 15% in restricted states. LAI prescriptions decreased by 1.2%, 3.3% and 7.3%, respectively. Commercially-insured individuals filled 4.1% more LAI claims in authorized states but 8.3% and 12.8% fewer claims in CPA and restricted states. Medicaid patients filled 1.8% fewer LAI prescriptions in authorized and CPA states and 5.8% fewer in restricted states, while Medicare patients filled 4.4%, 5.7%, and 5.7% fewer LAIs.

CONCLUSIONS

In the early months of the COVID-19 pandemic, oral antipsychotic use increased due to a transition to mail order, and LAI use decreased. Medicaid and Medicare patients had greater reductions in LAI use than commercial patients. State policies restricting pharmacist administration of LAIs affected utilization across all insurance groups.