The Pharmaceutical Research and Manufacturers of America (PhRMA) commissioned Milliman to analyze the relationship between medication adherence and inpatient (IP) and emergency department (ED) service rates within the U.S. Medicaid population nationwide, focusing specifically on beneficiaries diagnosed with respiratory conditions or mental health conditions. The respiratory conditions include asthma or chronic obstructive pulmonary disease (COPD), and mental health conditions include anxiety, depression, bipolar disorder, and schizophrenia. This analysis was limited to these diagnosis cohorts and to IP and ED use as markers of acute care. This report adds to the existing body of evidence showing that beneficiaries with respiratory or mental health conditions who adhere to their prescribed medication regimens generally experience significantly fewer inpatient and ED encounters than their non-adherent peers.

Key findings:

• The frequency of IP and ED services was nearly always lower for adherent beneficiaries diagnosed with asthma, COPD, or a mental health disorder compared with beneficiaries who were non-adherent or not using medication.
• Medication adherence was low for Medicaid beneficiaries, with fewer than 50% of beneficiaries adhering to their medication regimen within each condition analyzed.
• Beneficiaries with respiratory conditions with no medication use show higher-than-average service rates of both inpatient and ED services.
• Medicaid members with asthma who have non-adherent medication utilization show lower-than-average inpatient (-10.4%) and ED service rates (-8.6%).
• Beneficiaries with COPD who have non-adherent medication patterns show higher-than-average inpatient service rates (+3.9%) and lower-than-average ED service rates (-0.4%), but higher service rates than adherent beneficiaries.
• Members with mental health conditions but no medication use show higher-than-average service rates of ED services.
• Beneficiaries with non-adherent medication patterns show higher-than-average service rates of both inpatient and ED services for all mental health conditions.
• Adherent beneficiaries with schizophrenia show the lowest relative ED service rates (-29.5%), while adherent beneficiaries with depression show the lowest relative inpatient service rates (-14.1%).

Download the full report (PDF).

This report was commissioned by PhRMA.