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Forum for Health Economics & Policy

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Patient Outcomes and Cost Effects of Medicaid Formulary Restrictions on Antidepressants

Seth A. Seabury
  • Corresponding author
  • Associate Professor of Research, Department of Emergency Medicine and the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, USC Schaeffer Center, 635 Downey Way, VPD Suite 210, Los Angeles, CA 90089-3333, USA
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/ Darius N. Lakdawalla / Deborah Walter / John Hayes / Thomas Gustafson / Anshu Shrestha / Dana P. Goldman
Published Online: 2014-11-07 | DOI: https://doi.org/10.1515/fhep-2014-0016


Many state Medicaid programs have implemented policies designed to reduce spending on prescription drugs by restricting access to branded products. For patients with major depressive disorder, formulary restrictions could severely limit access to antidepressant therapies and disrupt care. We linked data on patient outcomes and spending from 24 state Medicaid programs to information on formulary restrictions from 2001 to 2008. Outcomes included frequency of MDD-related hospitalizations and ER visits per patient and total healthcare spending. We estimated the effect of the policies on patient outcomes and spending using a difference-and-difference approach. We found that restricting access to antidepressants increased the probability of an MDD-related hospitalization by 1.7 percentage points (16.6%). Furthermore, we found no evidence that these restrictions resulted in any net savings for Medicaid.

Keywords: depression; Medicaid; prescription drug coverage


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About the article

Corresponding author: Seth A. Seabury, PhD, Associate Professor of Research, Department of Emergency Medicine and the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, USC Schaeffer Center, 635 Downey Way, VPD Suite 210, Los Angeles, CA 90089-3333, USA, Phone: +310-623-2025, e-mail:

Published Online: 2014-11-07

Published in Print: 2014-09-01

Citation Information: Forum for Health Economics and Policy, Volume 17, Issue 2, Pages 153–168, ISSN (Online) 1558-9544, ISSN (Print) 2194-6191, DOI: https://doi.org/10.1515/fhep-2014-0016.

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