Characteristics and Utilization Patterns of Medicare Beneficiaries Initiating Long-Acting Injectable Antipsychotic Medications

Purpose: US Medicare beneficiaries in fee-for-service (FFS) and Medicare Advantage (MA) plans may differ in sociodemographics, treatment patterns, and healthcare costs, but real-world evidence is limited. Our objective was to gain a holistic understanding of Medicare beneficiaries using long-acting injectable antipsychotic medications (LAI-AM) as a case study. Patients and Methods: This observational study describes two distinct cohorts of new LAI-AM users enrolled in FFS or MA plans from July-2017 through December-2020. Data were extracted from the Centers for Medicare & Medicaid Services’ Chronic Conditions Data Warehouse (for FFS) and the Carelon Research Healthcare Integrated Research Database ® (for MA). Setting the first LAI-AM claim as index date, we identified adult beneficiaries enrolled for ≥ 12-months before (baseline) and after (follow-up) the index date. We described LAI-AM users’ sociodemographic and clinical characteristics, medication adherence (proportion of days covered [PDC]), and healthcare costs. Results: We identified 3180 FFS- and 525 MA-enrolled LAI-AM initiators. Compared to the MA cohort, the FFS cohort was younger (mean 49 vs 53 years), had more males (56% vs 45%), and had more living in the South and West. Many had a depressive mood disorder (70%) and/or substance use disorder (40%). The mean PDC was 0.52 (SD 0.34) for FFS and 0.46 (SD 0.34) for MA. Only 33% (FFS)/27% (MA) had a PDC≥ 0.8 (adherent). In both cohorts, total medical costs decreased and total pharmacy costs increased from baseline to follow-up. Conclusion: Differences in sociodemographic characteristics between FFS and MA plan LAI-AM initiators did not correspond with different patterns or costs of treatment.