"This is the first well-controlled study to show that health policies designed to reduce drug costs and abuse can increase racial disparities in access to effective care for those with chronic illnesses, like schizophrenia," said Pearson.
The authors examined the effects of a prescription-monitoring program on access to benzodiazepines among nearly 125,000 Medicaid enrollees living in neighborhoods of different racial composition. Benzodiazepines are widely prescribed and effective treatments when used appropriately for anxiety, panic, sleep, and seizure disorders. They are also adjunct therapies for people with chronic mental illness, such as bipolar disorder and schizophrenia. However, there is controversy about their risk of dependency and abuse.
The New York program that monitors use of benzodiazepines reduced problematic use and almost completely eliminated benzodiazepine abuse including pharmacy hopping, in the cohort of Medicaid patients followed. Yet larger groups of vulnerable patients also showed reduced access to appropriate use of benzodiazepines as a result of the monitoring program. Blacks had a lower baseline rate of benzodiazepine use as compared to whites and Hispanics, but also had the greatest reduction in use as a result of the monitoring policy.
"These findings suggest that well-intentioned health policies can exacerbate racial disparities," Ross-Degnan said.
Across all practice and pharmacy locations, black enrollees in Medicaid were consistently the most likely, and white enrollees the least likely, to experience reductions in access to benzodiazepines. The authors report that racial disparities in benzodiazepine use after introduction of the monitoring program were maintained six years later and are likely to be a problem in other states that use this regulatory approach. While decreasing abuse of the medications is desirable, these findings indicate that decreasing appropriate prescribing and access to benzodiazepines can have a negative affect on already vulnerable populations.
"The specific ways in which the policy causes these disparities remain unknown, but may include racial differentiation in treatment by medical providers and pharmacies reacting to incorrect beliefs about racial differences in abuse," Ross-Degnan said. "To eliminate disparities, we need a combination of social change, redesign of systems of care, and careful examination of policy impacts."
This work was funded by the National Institute on Drug Abuse (of the National Institutes of Health), the Harvard Medical School Fellowship Program in Pharmaceutical Policy, and the Harvard Pilgrim Health Care Foundation.
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Archives of Internal Medicine