March 13, 2006

Prescription program may up healthcare racial gap

NEW YORK (Reuters Health) - A program designed to reduce
inappropriate prescriptions for benzodiazepines, such as Xanax
and Valium, had the unintended consequence of increasing racial
disparities in access to care, according to a report in the
Archives of Internal Medicine.

"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," lead author
Dr. Sallie-Anne Pearson, from the University of New South Wales
in Sydney, Australia, said in a statement.

The findings are based on an analysis of data for 124,867
adults enrolled in New York Medicaid before and after a
triplicate prescription program (TPP) that included
benzodiazepines was implemented. The program requires that
physicians use multiple copy forms or the electronic equivalent
when prescribing certain drugs. Census data were analyzed to
determine the racial make-up of the neighborhoods included in
the study.

After the initiation of the TTP in 1989, a sudden and
sustained drop in benzodiazepine use was noted in all
neighborhoods, the report indicates. Even though predominantly
black neighborhoods had the lowest baseline rates of
benzodiazepine use, they had the greatest discontinuation rates
following TTP implementation.

After accounting for gender, eligibility status,
neighborhood poverty, and baseline use, black subjects were
about 78 percent more likely than whites to discontinue
non-problematic and potentially problematic benzodiazepine use.

"Hopping" from pharmacy to pharmacy in attempt to get
excess medications virtually disappeared in all ethnic groups
after TTP began, but the effect was less pronounced among
whites than blacks, the authors note.

"Although legislators should be satisfied that the TPP
almost completely eliminated pharmacy hopping, it is of concern
that the weight of the policy has fallen most heavily on
patients with the lowest rates of baseline use, and it is
further troubling that these recipients were identified on the
basis of race," the investigators conclude.

SOURCE: Archives of Internal Medicine, March 13, 2006.