Effects of the COVID-19 Pandemic on Prescription Drug Use for Anxiety and Depression among Medicaid Enrollees

The COVID-19 pandemic coincided with severe disruptions to healthcare delivery and a sharp deterioration in mental health, particularly among low-income populations. This study examines how the pandemic affected the utilization of prescription medications for anxiety and depression among Medicaid beneficiaries, a population especially vulnerable to both health and economic shocks. Using state-quarter Medicaid State Drug Utilization Data from 2014 to 2021, I estimate event study and difference-in-differences models to assess changes in mental health-related prescription use during the COVID-19 public health emergency. The results show that the pandemic was associated with a sustained increase in the share of all Medicaid prescriptions devoted to anxiety and depression, indicating heightened mental health burden among Medicaid enrollees. At the same time, prescriptions per enrollee for anxiety, depression, and all conditions declined, suggesting reduced utilization despite increased need. Differences across Medicaid expansion and non-expansion states highlight the role of insurance coverage in buffering access to care during systemic shocks. Relative to non-expansion states, Medicaid expansion states experienced higher prescription utilization and smaller declines in per-enrollee use during the pandemic. Overall, the findings underscore the importance of Medicaid expansion and program design in protecting access to mental health treatment during large-scale public health crises.