OBJECTIVES: Patient affordability is an important non-clinical consideration for treatment access. This study assessed out-of-pocket (OOP) costs for antipsychotic (AP) treatments among Medicaid beneficiaries with schizophrenia.

METHODS: Adults with a diagnosis of schizophrenia, ≥1 AP claim, and continuous 2018 Medicaid eligibility were identified in the MarketScan® Medicaid Database. Patients with any diagnosis of bipolar disorder were excluded. OOP pharmacy costs of APs ($US 2019) were assessed and normalized for a 30-day supply. Results were reported for overall APs, by route of administration (ROA; i.e., orals [OAPs] and long-acting injectables [LAIs]), and further stratified by generic/branded. Separately, OOP costs for branded paliperidone palmitate once-monthly (PP1M) and once-every-three-months (PP3M) LAIs were assessed.

RESULTS: Overall, 48,998 patients with schizophrenia were identified (mean age 46.6 years, 41.1% female, 49.0% Medicaid eligibility due to ‘blind/disabled individual’). The mean annual total OOP costs were $71, among which $7 was for APs. Overall, 39.3% of patients had OOP costs >$0 for any APs, 38.3% for OAPs, and 42.3% for LAIs. Assessing all pharmacy claims, the mean OOP costs per patient per 30-day claim (PPPC) for all, generic, and branded OAPs were $0.64, $0.61, and $1.15, respectively, and for LAIs were $0.86, $0.68, and $0.93, respectively. The mean OOP costs PPPC for PP1M/PP3M were <$1.00 ($0.86 and $0.39, respectively). Including all pharmacy claims, dependent on ROA and generic/branded, projected OOP AP costs per-patient-per-year for patients assumed fully adherent ranged from $6.96 to $13.70, representing <20% of total OOP costs. A replication using 2017 data yielded similar results.

CONCLUSIONS: Approximately 60% of Medicaid beneficiaries with schizophrenia have $0 OOP costs for LAIs and OAPs. Projected annual OOP AP costs represent <20% of total OOP costs; OOP costs were similar for LAIs and OAPs. The mean OOP cost for LAIs was <$1.00 (including PP1M/PP3M), with longer dosing intervals having lower OOP costs per 30-days.