Pronounced state-level variation in prescription cannabinoids to Medicaid patients

Dronabinol is approved for chemotherapy induced nausea as well as vomiting and HIV-induced anorexia, while cannabidiol is primarily approved for childhood epileptic disorders Lennox-Gastaut and Dravet syndrome. The use pattern for these prescription cannabinoids in the US is unknown. This study analyzed Medicaid claims for dronabinol and cannabidiol prescriptions from 2016-2020. Dronabinol prescriptions decreased by 25.3% from 2016 to 2020 while cannabidiol prescriptions increased by 16,272.99 % from 2018 to 2020. The spending on these drugs parallels that on their prescription trend with a 66.3% decrease in reimbursement for dronabinol ($5.7 million in 2020), whereas that of cannabidiol increased by +26,582.0% ($233.3 million in 2020). Dronabinol prescriptions in Connecticut were 136.4 times larger than New Mexico and 17 states had zero prescriptions. Idaho prescriptions, when corrected for number of enrollees, were 15.4-fold higher than Washington DC. Prescribing of dronabinol and cannabidiol did not differ significantly based on the whether the state had an active medical marijuana program. The prescriptions of pharmaceutical grade tetrahydrocannabinol were decreasing while cannabidiol was increasing. This study also identified pronounced state level variation in cannabinoid prescribing to Medicaid patients. Further research to identify the origins of these disparities is needed.