Pronounced Regional Variation in Esketamine and Ketamine Prescribing to US Medicaid Patients

ABSTRACT

Ketamine and esketamine are efficacious for treatment-resistant depression. Unlike other antidepressants, ketamine lacks a therapeutic delay and decreases the risk for suicide. This cross-sectional study geographically characterized ketamine and esketamine prescribing to United States (US) Medicaid patients. Ketamine and esketamine prescription rates and spending per state were obtained. Between 2009 and 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. 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 relative to the average state for esketamine in 2020. Ten states prescribed neither ketamine nor esketamine in 2020. Medicaid programs in 2020 spent 72.7-fold more for esketamine ($25.3 million) than on ketamine (0.3 million). Despite the effectiveness of ketamine and esketamine for treatment-resistant depression and anti-suicidal properties, their use among Medicaid patients was limited and highly variable in many areas of the US. Further research to better understand the origins of this state-level variation is needed.

KEYWORDS:

• bipolar
• depression
• pharmacoepidemiology
• pharmacotherapy
• suicide

Acknowledgments

Software used in this research was provided by the NIEHS (T32 ES007060-31A1). AGA and BJP were supported by HRSA (D34HP31025).

Disclosure statement

BJP was (2019-2021) part of an osteoarthritis research team supported by Pfizer and Eli Lilly. No potential conflict of interest was reported by the other authors.

Data availability statement

Raw data is available at: https://www.medicaid.gov/medicaid/prescription-drugs/state-drug-utilization-data/index.html

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/02791072.2023.2178558.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The work was supported by the National Institute of Environmental Health Sciences [T32-ES007060-31A1]; Health Resources Services Administration [D34HP31025]