Prescription Trends in Virginia’s Medicaid Population

The most recent Research Corner prior to this installment reviewed the 20 most common prescription medications for commercially insured Virginians listed in the All Payer Claims Database (APCD). The list was consistent with the population from which it was drawn – employed adults younger than 65 with health insurance as an employee benefit. This week, we consult the same APCD data to evaluate the most common prescriptions by volume for those insured under Medicaid. Medicaid coverage is available to Virginians who are medically indigent and meet state income eligibility guidelines. Enrollees generally fall in one of several categories: children in low-income families, pregnant women, elderly adults, individuals with disabilities, and parents meeting specific income thresholds. Of these groups, children in low-income families make up roughly half of the 1.3 million Virginians covered by Medicaid (see Figure 1). Assessing that population helps make sense of the differences between the most used prescriptions among the Medicaid population, and the commercially insured group, as reflected in APCD data (see Figure 2). Many of the medications associated with the Medicaid population are commonly used in pediatric care. The most commonly prescribed drug is amoxicillin. Amoxicillin is widely prescribed for childhood infectious illnesses such as otitis media, strep throat, impetigo, and pneumonia. Allergies and asthma are other common childhood ailments, and 20 percent of the prescriptions on the list are used to treat those conditions. An important caveat: While some children outgrow childhood asthma, others carry the disease into adulthood. That means the class of drugs to treat asthma can be used throughout the life span, so it is conceivable that some of the asthma prescriptions are for both child and adult patients. Drugs to treat attention deficient hyperactivity disorder (ADHD) are common in pediatric populations and show up as the tenth and twentieth most frequent prescriptions. In the commercial group, ADHD-related prescriptions appear as the fifteenth most common. Second on the list is hydrocodone/acetaminophen. That ranking may be attributable to Medicaid’s disabled population (that drug is the fourth most common prescription in the APCD commercially insured population). It is difficult, however, to determine if the increase is due to physical disability or driven by behavioral disabilities from this list. Opioid prescriptions show up two more times on the list at numbers 12 and 17. Prescription strength ibuprofen also is a frequently written prescription. Since 29 percent of all births are subsidized by Medicaid, it is not surprising to find prescription strength Vitamin D ranked fourth because it is commonly prescribed to pregnant women. The largest remaining drug group covers prescriptions to treat hypertension. In summary, the Medicaid-only listing of prescriptions by volume shows drugs frequently prescribed for pediatric populations. The second most common drug group is opioids. It is difficult to know if the greater volume of opioids in the Medicaid population is related to trauma or disability related to chronic pain, or opioid dependency. (7/1)

Figure 1

7-1-2016 A

Figure 2

7-1-2016 B