Home » Medicaid pharmaceutical use varies wildly in state; more narcotics prescribed than any other class of drug

Medicaid pharmaceutical use varies wildly in state; more narcotics prescribed than any other class of drug

LEXINGTON, Ky. (Oct. 12, 2012) — Newly published research from the University of Kentucky raises questions about the differences in the amounts of medicine taken by Medicaid recipients across the state.

For example, adults on Medicaid in Clinton and Simpson Counties — which are separated by just 65 miles along the Tennessee border in southern Kentucky — take vastly different amounts of medicine to treat acid reflux disease. Doctors often prescribe proton pump inhibitors, a class of medications that includes Prilosec, Nexium, and Prevacid, to treat patients with recurring heartburn, or acid reflux disease. Clinton County adults on Medicaid use proton pump inhibitors at a higher rate than anywhere else in Kentucky.  Just four counties to the west, Simpson County adults take one-fourth as much and have the second-lowest usage rate in the state.

The study author, Michael Childress, asks, “Why the difference between Clinton and Simpson Counties?  re they getting too much in Clinton County, too little in Simpson County, or the appropriate amounts in each?  If they are receiving the appropriate amounts, what is causing so much gastric distress in Clinton County?”

These are important questions because “Kentucky Medicaid spent over $214 million from 2000 to 2010 on proton pump inhibitors — one of the most costly classes of drugs for adults,” Childress said.

This is just one of the findings in a collaborative study between the University of Kentucky College of Communication and Information, the Center for Business and Economic Research (CBER) in the Gatton College of Business and Economics, the Institute for Pharmaceutical Outcomes and Policy in the UK College of Pharmacy, and funded by the Foundation for a Healthy Kentucky.

The study found that narcotics were prescribed to adult Medicaid patients in Kentucky more than any other class of drugs.

In Eastern Kentucky, where abuse of pain pills has become an epidemic, Medicaid patients received double or triple the quantity of narcotics that patients got in most other Kentucky counties, according to the Lexington Herald Leader, which reported earlier this week on the study.

Organized at the regional and county levels, the Kentucky Medicaid Pharmaceutical Utilization Guide, 2000-2010, provides information on the 50 most utilized pharmaceuticals in Kentucky with respect to prescriptions, costs and total grams.

The study found that more than 3.8 million prescriptions for narcotics were written for Kentucky adults on Medicaid during that time.

“The Medicaid program spent $212 million on pain medicine over those 11 years. The state paid about 30 percent of that, and the federal government picked up the rest,” the Herald Leader reported. (Read more.)

Other notable differences in prescription medicine provided through Medicaid in Kentucky include children in Henderson County who take medication used to treat attention deficit hyperactivity disorder (ADHD) at a rate 11 times higher than children in Leslie County; adults in Martin County who take analgesic narcotics — pain pills — at a rate 12 times greater than adults in Shelby County; and minority children in Bath County who take a class of antipsychotics at a rate nearly 26 times higher than minority children in Christian County — while the difference between white children in these two counties is virtually non-existent.

The report will enable citizens, health care providers, public health officials and health advocates to compare pharmaceutical utilization between different communities — which, according to Childress, “will hopefully provoke important public policy and public health questions, such as what accounts for the vastly different pharmaceutical utilization patterns across the state overall, between genders, and among races with respect to, for example, pain medication, ADHD drugs and antipsychotic medication.”

Understanding Medicaid pharmaceutical utilization in Kentucky is important, said Childress.

“Over $6.6 billion was spent in the state from 2000 to 2010 on outpatient medication, and it has the potential to fundamentally transform the health and well-being of individuals, and, by extension, the community at large,” he said.

He cautioned that “while our focus here is on Medicaid — an important program upon which thousands of Kentuckians depend — the issues discussed here are not unique to it.”

All of these issues have important implications for public health, education outcomes, and ultimately future economic performance — both at the individual and community levels. This information can facilitate the strategic allocation of resources dedicated to improving health literacy — among patients, health care providers, and the community at large — which is essential for containing health care costs and improving the health of our citizens, he said.

The report is available online at the CBER website.