9.4% Of Denied Prescription Fills For Atypical Antipsychotics Led To Acute Care Events & Higher Costs To Medicaid Programs

About 9.4% of Medicaid beneficiaries who experienced a procedural prescription denial in 2023 for an atypical antipsychotic had an acute care event within the next 60 days. After a first denied claim was followed by an acute care event, unadjusted per-member per-year (PMPY) spending increased by $276. The adjusted difference in spending for acute care for those with or without a medication denial was $1,539, with $1,263 of the increase directly attributed to the medication denial.

Health plans use procedural prescription denials to reduce immediate drug costs. A procedural denial can occur due to an . . .