From JAMA:
Key Points
Question How often do adults returning to the community from prison continue to access prescription medications, and what factors are associated with medication continuity?
Introduction
High morbidity and mortality characterize the period of transition following release from incarceration, making access to and continuation of health care during reentry an essential part of supporting a healthy return to the community.1,2 Rates of chronic illness among justice-involved adults are substantially higher than those observed in comparable populations without justice involvement, and the likelihood of receiving treatment for many chronic conditions in the community declines relative to during incarceration.3-6 Medication adherence can decrease morbidity, mortality, and health care costs, particularly among patients with chronic diseases.7,8 However, both financial and practical barriers to accessing prescription medications upon return to the community have been noted as disruptions to continuity of care by physicians who work with incarcerated and reentering populations.9
Increased eligibility for Medicaid, which typically allows access to prescriptions with little or no cost-sharing, may improve access to care among individuals recently released from prison, but access alone may not improve health if other critical barriers remain.10-12 Federal policy prohibits Medicaid coverage during incarceration, creating practical challenges in care access and coordination at release. The 2023 SUPPORT Act (Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment Act) requires the Centers for Medicare & Medicaid Services (CMS) to provide guidance on how states could improve care transitions through Medicaid 1115 reentry waivers.13 Eleven states have approved waivers, with 13 pending, and all include minimum requirements for case management, a 30-day supply of prescriptions at release, and post release appointment setup assistance.14
Limited access to medical records from correctional settings has stymied efforts to identify health care needs before individuals leave prison, and prior efforts to understand medication continuity post incarceration are qualitative, focus on a single disease, or both.15-18 We connected data on medication prescriptions from the carceral period to post release claims and identified individuals with likely ongoing medication treatment needs for chronic conditions. We aimed to determine the likelihood of continued prescription fills after release and identify demographic, carceral, and health care utilization factors associated with prescription medication continuity for certain medications commonly used to treat chronic conditions among adults returning to the community from prison.
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