Continuity of Prescription Medication Use Among Adults Leaving State Prison.

Importance: Identifying prescription needs of adults returning from prison can inform intervention design to mitigate high morbidity and mortality during reentry to the community. Objective: To characterize the prevalence and factors associated with continuity of medication use for treatment of chronic illness among adults returning to the community from prison. Design, Setting, and Participants: This retrospective cohort study linked administrative records and prescription claims from the Wisconsin Department of Corrections and the Medicaid program. The study included all adults (aged 18-64 years) released from a Wisconsin state correctional facility between April 1, 2015, and June 30, 2017, after incarceration of at least 31 days who enrolled in Medicaid within the month of release. Analyses were conducted between May 2022 and May 2024. Exposure: Receipt of a prescription medication commonly used for treatment of certain chronic conditions during the last 3 months of incarceration. Main Outcomes and Measures: The primary outcome was medication continuity, which was defined as having a prescription medication claim in the first 6 months after release that was within the same chronic condition therapeutic class as the medication received during the last 3 months of incarceration. Results: This cohort study included 13 792 individual releases representing 12 960 individuals from the Wisconsin state prison system who immediately enrolled in Medicaid upon release. These individuals had a mean (SD) age of 35.5 (10.5) years; 89.5% were male. In terms of race, 38.5% of individuals were Black and 57.2% were White. For one-third of individual Medicaid-enrolled releases (4302 [31.2%]), the individual received a prescription medication for a chronic condition. Prescription continuity was observed for 51.7%, with variability across drug class ranging from less than 20.0% to 71.6%. Classes with the highest continuity (eg, thyroid agents) were also those that treated serious chronic conditions, although gaps between realized and clinically recommended care remained. Continuity varied by race, sex, and age. Individuals with continuity were more likely to have had an outpatient visit in the 6 months following release than those without continuity (93.9% vs 55.6%; P < .001) despite similar Medicaid enrollment. Conclusions and Relevance: In this study, prescription continuity between prison release and the community was limited, even for drugs with high clinical need and relevance for population health and especially among individuals who did not receive outpatient care in the 6 months post incarceration. These findings suggest that effective transitional care interventions may need to include increased emphasis on connecting with clinicians.