Background: Ketamine and esketamine are efficacious for treatment resistant depression. Unlike other antidepressants, ketamine and esketamine lack a therapeutic delay and do not increase risk for suicidal thoughts and behaviors in adolescents and young-adults. Esketamine gained FDA approval in March of 2019.Objective: This cross-sectional study aimed to geographically characterize ketamine and esketamine prescribing to US Medicaid patients.Methods: Ketamine and esketamine prescription rate and spending per state were obtained from the Medicaid State Drug Utilization Database. States outside of a 95% Confidence Interval were considered statistically significant.Results: Between 2009-2020, ketamine prescribing rates peaked in 2013 followed by a general decline.For ketamine and esketamine in 2019, Montana (967/million enrollees) and Indiana (425) showed significantly higher prescription rates, respectively, relative to the national average. A total of 21 states prescribed neither ketamine nor esketamine in 2019. Since its approval, esketamine prescriptions have surpassed those of ketamine. There was a 121.3% increase in esketamine prescriptions from 2019 to 2020. North Dakota (1,423) and North Carolina (1,094) were significantly elevated for esketamine in 2020. Ten states prescribed neither ketamine nor esketamine in 2020. State Medicaid programs in 2020 spent 72.7 fold more for esketamine ($25.3 million) than on ketamine (0.3 million) prescriptions. Conclusion:Despite the effectiveness of ketamine and esketamine for treatment resistant depression, their use among Medicaid patients was limited and variable in many areas of the US.
BackgroundKetamine, and its isomer esketamine are useful for treatment resistant depression (depression not responsive to traditional antidepressants). Compared to other antidepressants, ketamine and esketamine lack a therapeutic delay and do not increase risk of suicidality in adolescents. Esketamine gained FDA approval in March of 2019.ObjectiveThis study aimed to geographically characterize ketamine and esketamine prescriptions in the United States among Medicaid patients.MethodsKetamine and esketamine prescription rate data per state per quarter were obtained from the Medicaid State Drug Utilization Database for 2019-2020. Total prescription rates per year for ketamine and esketamine were obtained for 2009-2020.ResultsBetween 2009-2020, ketamine prescribing rates peaked in 2013 followed by a general decline. For ketamine and esketamine prescriptions in 2019, Montana and Indiana showed significantly higher prescription rates, respectively, relative to the national average. A total of 21 states prescribed neither ketamine or esketamine in 2019. Since its approval, esketamine prescriptions have surpassed those of ketamine. There was a 121.3% increase in esketamine prescriptions from 2019 to 2020. Ten states prescribed neither ketamine or esketamine in 2020.ConclusionDespite the effectiveness of ketamine and esketamine for treatment resistant depression, their use among Medicaid patients was limited and variable in many areas of the US.
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