OBJECTIVES: To gain a holistic understanding of long-acting injectable antipsychotic medications (LAI-AM) among US Medicare beneficiaries enrolled in fee-for-service (FFS) and Medicare Advantage (MA).

METHODS: We used medical and pharmacy claims from two databases to compare qualitatively two distinct cohorts of LAI-AM users enrolled in FFS Medicare or MA plans between January 2017 and December 2020. We used a 5% random sample from the Centers for Medicare & Medicaid Services’ Chronic Conditions Data Warehouse to identify the FFS cohort and the Healthcare Integrated Research Database (HIRD®) maintained by Carelon Research to identify the MA cohort. Using the date of the first LAI-AM claim as an index date, we identified beneficiaries who were continuously enrolled for at least 12 months before and after LAI-AM initiation, did not use LAI-AMs during the 12 months prior to the index date, and were aged ≥18 at LAI-AM initiation.

RESULTS: We identified 3,180 FFS-enrolled and 525 MA-enrolled LAI-AM initiators. Compared to the MA cohort, the FFS cohort was younger on average on the index date (49 versus 53 years), and more likely to live in the South (39% vs. 16%) and West (20% vs. 3%). The sex and racial/ethnic compositions of the two cohorts were similar. Less than half of beneficiaries in both cohorts had schizophrenia or psychosis-related diagnoses before the index LAI-AM. In both cohorts, at baseline, approximately 70% had depression, bipolar, and other depressive mood disorders; 30% to 40% had a substance use disorder or experienced suicidal ideation; and 40% were obese or overweight. Approximately 70% to 80% in both cohorts initiated second-generation LAI-AMs and 90% of LAI-AMs were administered in pharmacies.

CONCLUSIONS: LAI-AM initiators were mostly similar in terms of demographic characteristics, prevalence of mental health conditions, and LAI formulation. FFS LAI-AM users were younger, likely reflecting differential enrollment patterns among disabled beneficiaries.