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Cano GH, Dean J, Abreu SP, Rodríguez AH, Abbasi C, Hinson M, Lucke-Wold B. Key Characteristics and Development of Psychoceuticals: A Review. Int J Mol Sci 2022; 23:ijms232415777. [PMID: 36555419 PMCID: PMC9779201 DOI: 10.3390/ijms232415777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022] Open
Abstract
Psychoceuticals have brought benefits to the pharmacotherapeutic management of central nervous system (CNS) illnesses since the 19th century. However, these drugs have potential side effects or lack high response rates. This review covers twenty drugs' biochemical mechanisms, benefits, risks, and clinical trial reports. For this study, medications from seven psychoceutical organizations were reviewed and evaluated. Nineteen drugs were chosen from the organizations, and one was selected from the literature. The databases used for the search were Pubmed, Google Scholar, and NIH clinical trials. In addition, information from the organizations' websites and other sources, such as news reports, were also used. From the list of drugs, the most common targets were serotonergic, opioid, and N-methyl-D-aspartate (NMDA) receptors. These drugs have shown promise in psychiatric illnesses such as substance abuse, post-traumatic stress disorder (PTSD), anxiety, depression, and neurological conditions, such as Parkinson's disease, traumatic brain injury, and neuroinflammation. Some of these drugs, however, are still early in development, so their therapeutic significance cannot be determined. These twenty drugs have promising benefits, but their clinical usage and efficacy must still be explored.
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Affiliation(s)
- Genaro Herrera Cano
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, USA
| | - Jordan Dean
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, USA
| | - Samuel Padilla Abreu
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, USA
| | | | - Cyrena Abbasi
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, USA
| | - Madison Hinson
- Wake Forest University School of Medicine, 475 Vine St, Winston-Salem, NC 27101, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
- Correspondence:
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Belenky N, Pence BW, Cole SR, Dusetzina SB, Edmonds A, Oberlander J, Plankey M, Adedimeji A, Wilson TE, Cohen J, Cohen MH, Milam JE, Adimora AA. Impact of Medicare Part D on mental health treatment and outcomes for dual eligible beneficiaries with HIV. AIDS Care 2019; 31:505-512. [PMID: 30189747 PMCID: PMC6342646 DOI: 10.1080/09540121.2018.1516283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022]
Abstract
Depression is common among women with HIV and untreated depression can result in poor quality of life and worsen HIV outcomes. Women with HIV who are dually enrolled in Medicaid and Medicare faced a potential disruption in medication access when Medicare Part D was implemented in 2006. The goal of this study was to estimate the effects of Medicare Part D implementation on antidepressant use, depressive symptoms, and hospitalization in Medicaid-Medicare dual eligible women with HIV. This study used 2003-2008 data from the Women's Interagency HIV Study. The effects of Medicare Part D were estimated using a difference-in-differences approach, adjusting for temporal trends using a matched control group of Medicaid-only enrollees. Before Medicare Part D implementation, dual eligibles differed from Medicaid-only enrollees in antidepressant use and hospitalization, despite having identical prescription drug coverage through Medicaid. For dual enrollees, the transition to Medicare Part D was not associated with changes in antidepressant use, depressive symptoms, or hospitalization. We did not find disruptive effects on antidepressant use and related outcomes among dual eligibles in this study. Stable antidepressant use may be due to better access to medical care for dual eligibles through Medicare both before and after Medicare Part D implementation, which may have eclipsed any effects of the transition. It may also signal that classification of antidepressants as a protected drug class under Medicare Part D was effective in preventing psychiatric medication disruption.
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Affiliation(s)
- Nadya Belenky
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stephen R. Cole
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Stacie B. Dusetzina
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Andrew Edmonds
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jonathan Oberlander
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Social Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael Plankey
- Division of Infectious Diseases and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Tracey E. Wilson
- Department of Community Health Sciences School of Public Health, State University of New York, Downstate Medical Center, Brooklyn, New York
| | - Jennifer Cohen
- Department of Clinical Pharmacy, University of California, San Francisco, California
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital and Rush University, Chicago, Illinois
| | - Joel E. Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Adaora A. Adimora
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, NC
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3
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Wade RL, Chen CC, De AP, Howard JC. Impact of Oxycodone HCl Extended-release Formulary Restrictions on Extended-release Opioid Market Share, Healthcare Resource Utilization and Costs in Commercial and Medicare Plans. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2017; 5:75-88. [PMID: 37664692 PMCID: PMC10471421 DOI: 10.36469/9800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background: Previous research demonstrated that utilization management (UM) such as prior authorization (PA) or non-formulary (NF) restrictions may reduce pharmacy costs when designed and applied appropriately to certain drug classes. However, such access barriers may also have unintended consequences. Few studies systemically analyzed the impact of major UM strategies to extended-release (ER) opioids on different types of health plans. Objective: This study evaluated, from payer perspective, the impact of formulary restrictions (PA, NF, or step therapy [ST]) for branded oxycodone HCl extended release (OER) on market share, and healthcare resource utilization/costs in ER opioids patients for multiple types of health plans in the United States. Methods: This retrospective, longitudinal case-control study analyzed prescription and outpatient medical claims data (2012 to 2015) for adult ER opioid patients from US plans (commercial,/Medicare, national/regional) that instituted OER PA, NF, or ST. Patients from each restricted plan (cases) were matched to patients in an unrestricted plan (controls) on key patient characteristics. ER opioid market share and healthcare resource utilization/costs for both cases and controls were evaluated for the 6-month period before and after the formulary restriction dates. A difference-in-differences (DiD) approach was utilized to evaluate change in the total per patient per month (PPPM) healthcare utilization and costs. Results: The study comprised 1622 (national commercial PA), 2020 (regional commercial PA), 34 703 (national commercial ST), and 4372 (national Medicare NF) cases and equivalent number of controls. OER market share decreased after the formulary restrictions, with the national Medicare NF plan showing the greatest decrease (9.2%). DiD analyses indicated that PPPM office visit change in the PA and NF plans were non-significant (decreased by 0.1 and 0.2, P>0.05), but significant in the ST plan (increased by 0.1, P=0.0001). For most plans, no significant total monthly cost change was observed; PPPM costs decreased by $48.74 and $59.87 in ST and regional PA plans and increased by $37.90 in national NF plans (all P>0.05). Conclusions: This study observed that despite reducing the market share of OER, OER formulary restrictions had negligible impact on overall ER opioid utilization, and did not result in substantial pharmacy/medical cost savings.
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Nevo ON, Gold J, Hawk S. Evaluation of a prior authorization policy on compliance with VA pharmacy benefits management services recommendations for antipsychotic selection. Ment Health Clin 2015. [DOI: 10.9740/mhc.2015.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction:
A previous study at Veterans Affairs (VA) Eastern Colorado Health Care System revealed low rates of compliance with VA Pharmacy Benefits Management Services recommendations for antipsychotic selection in schizophrenia and schizoaffective disorders. As a result, formulary restrictions of second-line antipsychotics were implemented. Since April 2013, new starts of second-line antipsychotic agents require a prior authorization drug review. The objectives of this study were to evaluate the impact of the prior authorization process on compliance with the VA criteria for prescribing aripiprazole, olanzapine, and ziprasidone. The primary objective was to compare compliance rates with VA antipsychotic selection criteria preimplementation and postimplementation of the prior authorization drug review policy.
Methods
Single center, retrospective chart review of patients receiving aripiprazole, olanzapine, and ziprasidone. A report of all patients receiving a prescription for the above 3 agents between April 8, 2013, and December 6, 2013, was generated from the electronic medical record system. Charts were reviewed manually to determine compliance.
Results
One hundred forty-two unique patients were started on aripiprazole, olanzapine, and/or ziprasidone. Ninety percent of patients met VA criteria for use of these second-line antipsychotic agents, compared to 26% of patients prior to implementation of the prior authorization drug review. Overall prescribing of these agents decreased by 60%, resulting in an estimated cost avoidance of $617 389.
Discussion
Implementation of a prior authorization drug request for aripiprazole, olanzapine, and ziprasidone was associated with increased compliance with VA criteria for use of antipsychotic agents and with marked cost avoidance due to the reduced use of more expensive second-line antipsychotic agents.
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Affiliation(s)
- Ofir Noah Nevo
- (Corresponding author) PGY2 Psychiatric Pharmacy Resident, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado,
| | - Jeffrey Gold
- Mental Health Clinical Pharmacy Specialist, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Sherri Hawk
- Pharmacoeconomist and Clinical Pharmacist, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
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Affiliation(s)
| | - David B Menkes
- Waikato Clinical Campus, University of Auckland, Hamilton 3240, New Zealand
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Basu A, Meltzer HY. Tying comparative effectiveness information to decision-making and the future of comparative effectiveness research designs: the case for antipsychotic drugs. J Comp Eff Res 2014; 1:171-80. [PMID: 24237376 DOI: 10.2217/cer.12.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The outcome of comparative effectiveness research on antipsychotic drugs, specifically the National Institute of Mental Health-funded CATIE trial, has raised questions regarding the value of second-generation antipsychotic drugs and has sparked a debate regarding their accessibility through public insurance. We reviewed the evidence on the impact of access restrictions for antipsychotic drugs in Medicaid programs and found that such restrictions resulted in increases in overall costs and a possible decline in the quality of care. We attribute this unwanted outcome to limitations in comparative effectiveness research designs that fail to inform either clinical or policy decision-making. We enumerate these limitations and illustrate the potential for more innovative comparative effectiveness research designs that may be in line with clinical decision-making using an original analysis of the CATIE trial data. The value of genomic information in enabling better trial design is also discussed.
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Affiliation(s)
- Anirban Basu
- Department of Health Services, PORPP, University of Washington, 1959 NE Pacific St, Box-357660, Seattle, WA 98195-7660, USA.
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7
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Mascareñas CA, Oliveira R. Dynamics of drug evaluation: Formulary placement of antipsychotics. Ment Health Clin 2013. [DOI: 10.9740/mhc.n172348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Formulary management for psychotropic medications can be more difficult compared to other medication classes, as the same medications can produce significantly different results in individual patients. This article reviews various factors which should be examined when deciding which antipsychotics to include on a formulary.
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Affiliation(s)
- Cynthia A. Mascareñas
- 1 Pharmacy Service, South Texas Veterans Health Care System (STVHCS), San Antonio, TX
- 2 Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX
- 3 Pharmacotherapy Education & Research Center, School of Medicine, UTHSCSA, San Antonio, TX
| | - Rosana Oliveira
- 1 Pharmacy Service, South Texas Veterans Health Care System (STVHCS), San Antonio, TX
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Wu MY, Kennedy J, Cohen LJ, Wang CC. Coverage of atypical antipsychotics among medicare drug plans in the state of washington: changes between 2007 and 2008. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2012; 11:316-21. [PMID: 20098523 DOI: 10.4088/pcc.08m00737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine changes in the cost and coverage of atypical antipsychotics among Medicare prescription drug plans and Medicare advantage plans in the state of Washington. METHOD Coverage and cost data were obtained in February 2007 and 2008 from the Medicare Prescription Drug Plan Finder, an online database administered by the Centers for Medicare and Medicaid Services. Premiums, deductibles, out-of-pocket costs, and coverage limits were compared for prescription drug plans (PDPs) and for Medicare advantage plans (MAPs). RESULTS The number of PDPs in the state of Washington fell slightly from 57 in 2007 to 53 in 2008, while the number of MAPs rose from 43 in 2007 to 52 in 2008. In 2008, the mean monthly drug premium increased by 15% among PDPs and by 20% among MAPs. Mean copayments for the majority of atypical antipsychotics increased from 2007 to 2008. More plans added quantity limits for atypical antipsychotics, but use of other pharmacy management tools varied by type of plan and antipsychotic. CONCLUSIONS PDP and MAP participants in the state of Washington paid more for atypical antipsychotics in 2008 than they did in 2007. Affordability of atypical antipsychotics continues to be a concern, particularly for beneficiaries who are not eligible for Medicaid or the low-income subsidy.
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Affiliation(s)
- Meng-Yun Wu
- Department of Health Policy and Administration, College of Pharmacy, Washington State University, Spokane, Washington, USA.
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9
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Domino ME. Does managed care affect the diffusion of psychotropic medications? HEALTH ECONOMICS 2012; 21:428-43. [PMID: 21384465 PMCID: PMC3138820 DOI: 10.1002/hec.1723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 11/17/2010] [Accepted: 01/11/2011] [Indexed: 05/30/2023]
Abstract
Newer technologies to treat many mental illnesses have shown substantial heterogeneity in diffusion rates across states. In this paper, I investigate whether variation in the level of managed care penetration is associated with changes in state-level diffusion of three newer classes of psychotropic medications in fee-for-service Medicaid programs from 1991 to 2005. Three different types of managed care programs are examined: capitated managed care, any type of managed care and behavioral health carve-outs. A fourth-order polynomial fixed effect regression model is used to model the diffusion path of newer antidepressant and antipsychotic medications controlling for time-varying state characteristics. Substantial differences are found in the diffusion paths by the degree of managed care use in each state Medicaid program. The largest effect is seen through spillover effects of capitated managed care programs; states with greater capitated managed care have greater initial shares of newer psychotropic medications. The influence of carve-outs and of all types of managed care combined on the diffusion path was modest.
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Affiliation(s)
- Marisa E Domino
- The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA.
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10
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ATUN RIFATA, GUROL-URGANCI IPEK, SHERIDAN DESMOND. UPTAKE AND DIFFUSION OF PHARMACEUTICAL INNOVATIONS IN HEALTH SYSTEMS. INTERNATIONAL JOURNAL OF INNOVATION MANAGEMENT 2011. [DOI: 10.1142/s1363919607001709] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Multiple interacting factors influence the uptake and diffusion of medicines which are critical to improving health. However, there is a gap in our knowledge on how regulatory policies and other national health systems attributes combine to impact on the utilisation of innovative drugs, and health system goals and objectives. Our review demonstrates that strong regulation adversely affects, access to innovation, reduces incentives for research-based firms to develop innovative products and leads to short- and long-term welfare losses. Short-term efficiency gains from reducing pharmaceutical expenditures may actually increase total healthcare costs, reduce user choice, and in some cases, adversely affect health outcomes. Decision makers need to adopt a holistic approach to policy making, and consider potential impact of regulations on the uptake and diffusion of innovations, innovation systems and health system goals.
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Affiliation(s)
- RIFAT A. ATUN
- Centre for Health Management, Tanaka Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - IPEK GUROL-URGANCI
- Centre for Health Management, Tanaka Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - DESMOND SHERIDAN
- Department of National Heart and Lung Institute, Imperial College London and St Mary's Hospital, Norfolk Place, London, W2 1PG, UK
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Abouzaid S, Jutkowitz E, Foley KA, Pizzi LT, Kim E, Bates J. Economic impact of prior authorization policies for atypical antipsychotics in the treatment of schizophrenia. Popul Health Manag 2011; 13:247-54. [PMID: 20879905 DOI: 10.1089/pop.2009.0063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Prior authorization (PA) policies are increasingly being used to manage atypical antipsychotic (AA) Medicaid drug expenditures; however, some studies suggest that PAs may actually lead to higher rates of treatment discontinuation and hospitalization. A decision analytic model was developed to compare the cost of schizophrenia treatment from a Medicaid perspective when a PA policy for AA is in place with the cost of no PA, over a 1-year time horizon. Deterministic sensitivity analyses were conducted to assess the robustness of the model results when the parameters were varied. A second analysis was performed to assess the incremental impact of PA on hospitalization. The base case model calculates the mean yearly total medical cost for a patient with schizophrenia to be $12,967 (SD $798) under the PA arm and $12,996 (SD $925) with no PA. Results of the probabilistic sensitivity analysis suggest that PA is likely to produce modest cost savings 56% of the time. Analysis of the incremental impact of hospitalization on treatment cost showed that just a 0.5% increase in hospitalization rate in the PA arm will make the PA arm more costly. This analysis suggests that PA is likely to produce only modest cost savings approximately half the time. Sensitivity analyses show that small increases in hospitalizations will make PA the more costly option. Rigorous analysis of the PA policy for AAs is required to ensure that attempts to reduce pharmacy spending do not increase the risk for negative medical outcomes that would offset benefits.
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Affiliation(s)
- Safiya Abouzaid
- Jefferson School of Population Health, Thomas Jefferson University , Philadelphia, Pennsylvania, USA.
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12
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Lu CY, Adams AS, Ross-Degnan D, Zhang F, Zhang Y, Salzman C, Soumerai SB. Association between prior authorization for medications and health service use by Medicaid patients with bipolar disorder. Psychiatr Serv 2011; 62:186-93. [PMID: 21285097 PMCID: PMC3053119 DOI: 10.1176/ps.62.2.pss6202_0186] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the association between a Medicaid prior-authorization policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. METHODS A pre-post design with a historical comparison group was used to analyze Maine Medicaid and Medicare claims data. A total of 946 newly treated patients were identified during the eight-month policy (July 2003-February 2004), and a comparison group of 1,014 was identified from the prepolicy period (July 2002-February 2003). Patients were stratified by number of visits to community mental health centers (CMHCs) before medication initiation (proxy for illness severity): CMHC attenders, at least two visits; nonattenders, fewer than two. Changes in rates of medication discontinuation and outpatient, emergency room, and hospital visits were estimated. RESULTS Compared with nonattenders, at baseline CMHC attenders had substantially higher rates of comorbid mental disorders and use of medications and health services. The policy was associated with increased medication discontinuation among attenders and nonattenders, reductions in mental health visits after discontinuation among attenders (-.64 per patient per month; p<.05), and increases in emergency room visits after discontinuation among nonattenders (.16 per patient per month; p<.05). During the eight-month policy period, the policy had no detectable impact on hospitalization risk. CONCLUSIONS The prior-authorization policy was associated with increased medication discontinuation and subsequent changes in health service use. Although small, these unintended effects raise concerns about quality of care for a group of vulnerable patients. Long-term consequences of prior-authorization policies on patient outcomes warrant further investigation.
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Affiliation(s)
- Christine Y Lu
- Department of Population Medicine, Harvard Medical School, 133 Brookline Ave., 6th Floor, Boston, MA 02215, USA
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13
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14
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Kim E, Gupta S, Bolge S, Chen CC, Whitehead R, Bates JA. Adherence and outcomes associated with copayment burden in schizophrenia: a cross-sectional survey. J Med Econ 2010; 13:185-92. [PMID: 20235753 DOI: 10.3111/13696991003723023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Assess the association of schizophrenia patients' perceived copayment burden with medication adherence and outcomes. METHODS Patients with schizophrenia (aged 18+) completed self-reported questionnaires. Analyses included those currently using a second-generation antipsychotic (SGA) with no exposure to clozapine or depot formulation antipsychotics. Adherence was assessed using the Morisky Medication Adherence Scale (MMAS). Outcomes included emergency room (ER) use, hospitalization, attempted suicide, missed work due to health, and experiencing severe psychological distress. Logistic regression was used to adjust for demographics, health characteristics, psychotropic medication use, and insurance status. RESULTS Of 351 schizophrenia patients, 39% perceived copayment burden. These patients were less than half as likely to have complete adherence [OR = 0.427; 95% CI:0.257, 0.711; p = 0.001] Copayment burden was associated with greater likelihood of ER use, [OR = 2.157; 95% CI:(1.322, 3.520); p = 0.002], hospitalization [OR = 2.512; 95% CI: (1.475, 4.277); p < 0.001], attempted suicide[OR = 2.385; 95% CI: (1.156, 4.920); p = 0.019], severe psychological distress [OR = 1.833; 95% CI:1.092, 3.075; p = 0.022] and greater likelihood of missing work [OR = 7.193; 95% CI: 2.554, 20.256; p < 0.001]. CONCLUSIONS Copayment burden is associated with poorer medication adherence and outcomes. Formularies that reduce copayment burden for SGAs may positively affect medication adherence and outcomes among schizophrenia patients. LIMITATIONS Patient data were self-reported, which may have introduced additional bias in the study measures. Also, the use of a cross-sectional design precludes causal inference and the use of the current sampling methodology (both interview and Internet panel) might impact the ability to generalize the results to the broader population.
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Affiliation(s)
- Edward Kim
- Bristol-Myers Squibb, Plainsboro, NJ, USA
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15
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Containing Cost Despite the Cost. Med Care 2010; 48:1-3. [DOI: 10.1097/mlr.0b013e3181caad9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Donohue JM, Huskamp HA, Zuvekas SH. Dual eligibles with mental disorders and Medicare part D: how are they faring? Health Aff (Millwood) 2009; 28:746-59. [PMID: 19414883 DOI: 10.1377/hlthaff.28.3.746] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2006, six million beneficiaries who were eligible for both Medicare and Medicaid switched from Medicaid to Medicare Part D for coverage of their prescription drugs. This change led to an expanded role for Medicare in financing psychotropic medications for dual eligibles. A reduction in the number of plans serving these beneficiaries and an increase in utilization restrictions for some psychotropics since 2006 raise concerns about access to medications for dual eligibles with mental disorders and point to potential problems with adverse selection. To improve access for this population, Medicare might consider changes to its enrollment and risk-sharing systems.
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Affiliation(s)
- Julie M Donohue
- University of Pittsburgh Graduate School of Public Health, USA.
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17
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Zuvekas SH, Meyerhoefer CD. State variations in the out-of-pocket spending burden for outpatient mental health treatment. Health Aff (Millwood) 2009; 28:713-22. [PMID: 19414879 DOI: 10.1377/hlthaff.28.3.713] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We examine the potential of mental health/substance abuse (MH/SA) parity laws to reduce the out-of-pocket spending burden for outpatient treatment at the state level by exploring cross-state variations and their causes, as well as the provisions of MH/SA parity laws. We find modest (yet important) variation in out-of-pocket burden across states overall, but-because prescription medications account for two-thirds of out-of-pocket spending and are generally beyond the scope of recently enacted federal parity laws-evidence suggests that those laws will do little to reduce the observed burden or its variation. Other policy measures, designed to expand and improve health insurance coverage or reduce racial/ethnic disparities, could have a more profound impact.
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Affiliation(s)
- Samuel H Zuvekas
- Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland, USA.
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18
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Rosenheck RA, Davis S, Covell N, Essock S, Swartz M, Stroup S, McEvoy J, Lieberman J. Does switching to a new antipsychotic improve outcomes? Data from the CATIE Trial. Schizophr Res 2009; 107:22-9. [PMID: 18993031 DOI: 10.1016/j.schres.2008.09.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 09/22/2008] [Accepted: 09/29/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous analysis of data from CATIE showed that patients randomly assigned to switch to a new medication were more likely to discontinue study drug than those who stayed on the medication they had been taking prior to randomization. This study addresses additional outcomes measures evaluating symptoms, neurocognition, quality of life, neurological side effects, weight, and health costs. First, considering patients randomized to olanzapine or risperidone, outcomes among patients who had been on the drug to which they were randomized prior to CATIE (N=129 "stayers") were compared to outcomes of those who switched to either of these two drugs (N=269 "switchers"). A second set of analyses considered patients on baseline monotherapy with olanzapine (N=297); risperidone (N=252) or quetiapine (n=87) and compared those randomly assigned to stay on each of these medications with those assigned to switch to any of the other five phase 1 medications in CATIE. In mixed models of each outcome the independent variable of primary interest represented stay vs. switch, with multivariate adjustment for potential confounding factors. RESULTS With one exception, there were no significant differences between stayers and switchers on any outcome measure in either set of analyses. The exception was that, in the second set of analyses, patients who stayed on olanzapine showed greater weight gain than those who switched from olanzapine to other drugs. CONCLUSION Switching to a new medication yielded no advantage over staying on the previous medication. Staying on olanzapine was associated with greater weight gain.
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Soumerai SB, Zhang F, Ross-Degnan D, Ball DE, LeCates RF, Law MR, Hughes TE, Chapman D, Adams AS. Use of atypical antipsychotic drugs for schizophrenia in Maine Medicaid following a policy change. Health Aff (Millwood) 2008; 27:w185-95. [PMID: 18381404 DOI: 10.1377/hlthaff.27.3.w185] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
More than one-third of Medicaid programs and Medicare Part D plans use prior authorization (PA) policies to control the use of atypical antipsychotics (AAs). We used Medicaid and Medicare claims data to investigate how Maine's PA policy affected AA use, treatment discontinuities, and spending among schizophrenia patients initiating AA therapy. Patients initiating AAs during Maine's policy experienced a 29 percent greater risk of treatment discontinuity than patients initiating AAs before the policy took effect; no change occurred in a comparison state. AA spending was slightly lower in both states. Observed increases in treatment discontinuities without cost savings suggest that AAs should be exempt from PA for patients with severe mental illnesses.
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Affiliation(s)
- Stephen B Soumerai
- Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, in Boston, Massachusetts, USA.
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21
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Horgan CM, Reif S, Hodgkin D, Garnick DW, Merrick EL. Availability of addiction medications in private health plans. J Subst Abuse Treat 2008; 34:147-56. [PMID: 17499959 PMCID: PMC2347353 DOI: 10.1016/j.jsat.2007.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 01/23/2007] [Accepted: 02/16/2007] [Indexed: 11/21/2022]
Abstract
Health plans have implemented cost sharing and administrative controls to constrain escalating prescription expenditures. These policies may impact physicians' prescribing and patients' use of these medications. Important clinical advances in the pharmacological treatment of addiction highlight the need to examine how pharmacy benefits consider medications for substance dependence. The extent of restrictions influencing the availability of these medications to consumers is unknown. We use nationally representative survey data to examine the extent and stringency of private health plans' management of naltrexone and disulfiram for alcohol dependence, and buprenorphine for opiate dependence. Thirty-one percent of insurance products excluded buprenorphine from formularies, whereas 55% placed it on the highest cost-sharing tier. Generic naltrexone is the only substance dependence medication that is both rarely excluded from formularies and usually placed on a lower cost-sharing tier. These findings demonstrate that pharmacy benefits have an impact on access to medications for substance abuse.
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Affiliation(s)
- Constance M Horgan
- Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02454, USA.
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Effects of a Psychotherapeutic Drug Prior Authorization (PA) Requirement on Patients and Providers: A Providers’ Perspective. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2007; 35:181-8. [DOI: 10.1007/s10488-007-0158-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 11/20/2007] [Indexed: 10/22/2022]
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Hodgkin D, Horgan CM, Garnick DW, Len Merrick E, Volpe-Vartanian J. Management of access to branded psychotropic medications in private health plans. Clin Ther 2007; 29:371-80. [PMID: 17472830 DOI: 10.1016/j.clinthera.2007.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2007] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the past decade, health insurers have increased their reliance on cost control policies such as prior authorization and 3-tier formularies. Little is known about how these policies are being applied to psychotropic medications, many of which have low rates of patient adherence. OBJECTIVE This study reports on plans' cost-sharing tier placement and authorization policies for 12 brand only psychotropic medications in 3 classes: antidepressants, anti-psychotics, and medications for attention deficit/hyperactivity disorder (ADFID). METHODS Data were from a nationally representative survey of private health plans regarding mental health and substance-abuse services in 2003; 368 plans responded (83% response rate). Results were weighted and represent national estimates of health-plan characteristics. RESULTS The majority of insurance products provided unrestricted placement on Tier 2 (medium copayment) for at least 2 brand-only antidepressants and at least 2 brand-only antipsychotics. This approach allows clinicians some limited leeway in initial medication selection. However, most patients who did not respond to the Tier-2 options typically faced a substantial escalation in copayment (Tier 3), possibly leading to premature medication discontinuation. For ADHI)5 the options were considerably more limited, with 22.1% of products applying some restriction to all 3 medications and only 15.9% of products leaving all 3 medications unrestricted. Plans with specialty contracts for mental health were considerably more likely to use Tier 3 (highest copayment) as their only restriction approach. CONCLUSIONS Based on the results of this analysis,private plans were managing psychotropic costs using copayment incentives rather than administrative controls. This approach was less intrusive for clinicians, but resulting higher copayments could worsen already high rates of nonadherence; future research should examine this issue.
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Affiliation(s)
- Dominic Hodgkin
- Institute for Behavioral Health, Schneider Institutes, Heller School of Social Policy and Management,Brandeis University, Waltham, Massachusetts 02454-9110, USA.
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Shih YCT, Bekele NB, Xu Y. Use of Bayesian net benefit regression model to examine the impact of generic drug entry on the cost effectiveness of selective serotonin reuptake inhibitors in elderly depressed patients. PHARMACOECONOMICS 2007; 25:843-62. [PMID: 17887806 DOI: 10.2165/00019053-200725100-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Since their invention in the late 1980s and early 1990s, selective serotonin reuptake inhibitors (SSRIs) have become the primary form of pharmaceutical treatment for depression. As the patents of several top-selling SSRIs have expired or are soon to be expired, the SSRI market is expected to witness an increasing share of generic SSRIs. We explored the impact of generic drug entry on the cost effectiveness of SSRIs. METHOD Using Medicare MarketScan claims data, we compared the cost effectiveness of sertraline, citalopram, escitalopram and fluoxetine with paroxetine in elderly depressed patients, before and after the entry of generic paroxetine. We followed users of SSRIs for 6 months, starting from the date of their first prescription of an SSRI. For each patient, we measured costs (C(i)) as total medical costs and quantified effectiveness (E(i)) as the avoidance of treatment failure, which was defined as having a break exceeding 45 days in the use of antidepressants. We then calculated individual net benefit as lambda x E(i)- C(i) and employed both net benefit and Bayesian net benefit regression models to examine the impact of generic paroxetine on the cost effectiveness of the other four SSRIs compared with paroxetine, while controlling for patients' sociodemographic characteristics, co-morbidities and patterns of medication switch. RESULTS Deterministic analysis showed that paroxetine was dominated by most SSRIs prior to the availability of generic paroxetine, and that, after the entry of generic paroxetine, citalopram and escitalopram were dominated by paroxetine. Net benefit regression analysis found that, at a number of lambda values ($US1000, $US5000 and $US10,000), sertraline and escitalopram were more cost effective than paroxetine in the pre-generic-entry period but not in the post-entry period, although the difference in net benefit between the two SSRIs and paroxetine was not statistically significant in both periods. The Bayesian net benefit regression analysis reached similar conclusions. At lambda = $US5000, the probability that sertraline, citalopram, escitalopram or fluoxetine was more cost effective than paroxetine was 96.7%, 77.6%, 96.3% and 97.0%, respectively, in the pre-entry period in the pooled analysis. These probabilities reduced to 36.7%, 62.7%, 33.0% and 60.1%, respectively, in the post-entry period. The probabilities became 94.1%, 71.9%, 89.1% and 92.1% in analysis using the pre-entry data as a prior to update the post-entry data rather than using the pooled data. CONCLUSION Using generic drug entry as an example, our study demonstrated the importance of including the economic life cycle of pharmaceuticals in cost-effectiveness analyses. Additionally, the proposed Bayesian framework not only preserves the advantages of the net benefit regression framework, but more importantly, it introduces the possibility of conducting probabilistic cost-effectiveness analyses with claims data.
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Affiliation(s)
- Ya-Chen Tina Shih
- Department of Biostatistics, Division of Quantitative Sciences, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
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Abstract
The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 represents the most significant expansion of Medicare benefits since the program's inception and has important implications for mental health. Medicare will become a major payer for psychotropic medications through the new prescription drug benefit. The structure of the drug benefit's delivery system creates incentives for plans to underprovide medications, like psychotropic drugs, that are used persistently and are associated with high expected costs. Regulators have put policies in place to counteract these incentives. This paper examines these strategies' likely success and suggests additional approaches to be considered.
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Affiliation(s)
- Julie Donohue
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA.
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Huskamp HA. Prices, profits, and innovation: examining criticisms of new psychotropic drugs' value. Health Aff (Millwood) 2006; 25:635-46. [PMID: 16684726 PMCID: PMC2430611 DOI: 10.1377/hlthaff.25.3.635] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
High profits and high drug costs have brought increased scrutiny of the pharmaceutical industry over the issue of whether the drugs they produce are worth the costs. I examine several related complaints, including the proliferation of me-too drugs and product reformulations, which some argue have little value relative to their cost; the baseless promotion of newer drug classes as more effective than existing, less expensive drugs; legal strategies to extend market exclusivity that result in high brand-name drug prices for an extended period of time; and large promotional expenditures that result in higher prices.
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Huskamp HA, Shinogle JA. Economic grand rounds: potential effects of the new medicare drug benefit on pricing for psychotropic medications. Psychiatr Serv 2005; 56:1056-8. [PMID: 16148317 PMCID: PMC1403293 DOI: 10.1176/appi.ps.56.9.1056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Haiden A Huskamp
- Harvard Medical School, 180 Longwood Ave, Boston, Massachusetts 02115, USA.
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Huskamp HA. Pharmaceutical cost management and access to psychotropic drugs: the U.S. context. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2005; 28:484-95. [PMID: 16150490 PMCID: PMC1378114 DOI: 10.1016/j.ijlp.2005.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
In recent years, prescription drug expenditures in the United States have increased rapidly. In 2003, spending on prescription medications totaled $179.2 billion dollars, or approximately 11% of national health expenditures [Smith, C., Cowan, C., Sensenig, A., Catlin, A., the Health Accounts Team. (2005). Health spending growth slows in 2003. Health Affairs, 24 (1) 185-194]. In response to rapid increases in prescription drug expenditures, both public and private payers of health care services have adopted strategies to try to contain drug costs, including drug formularies, prior authorization programs, cost sharing and utilization management. In this paper, I provide a background on prescription drug spending trends, financing, and access to medications; describe some of the tools used most commonly to manage prescription drug utilization; present results from the literature on the impact of these tools; and discuss some implications of this information for the new Medicare prescription drug benefit to be implemented in 2006 as well as for future prescription drug innovation.
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Affiliation(s)
- Haiden A Huskamp
- Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115, United States.
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Abstract
This study reviews Medicaid policies to restrict access to psychiatric medications. Policies on prior authorization, preferred drug lists, limitations on the number of prescriptions, fail-first requirements, and use of generics are reviewed. All states apply one or more of those policies to medications for mental illness, and many apply several. A large number of states have legislated exemptions from those policies for certain medications, particularly antipsychotics and antidepressants. Other psychiatric medications are less well protected. Some states appear to restrict access severely. Questions have been raised as to whether these policies actually save money in the long term.
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Affiliation(s)
- Chris Koyanagi
- Bazelon Center for Mental Health Law, Washington, DC, USA
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Zuvekas SH, Rupp AE, Norquist GS. Spillover effects of benefit expansions and carve-outs on psychotropic medication use and costs. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2005; 42:86-97. [PMID: 16013588 DOI: 10.5034/inquiryjrnl_42.1.86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This paper extends the previous literature examining the impacts of managed behavioral health care carve-outs and mental health parity mandates on mental health and substance abuse (MH/SA) specialty treatment use and costs by considering the effects on psychotropic prescription medication costs. We use multivariate panel data methods to remove underlying secular growth trends, driven by increased demand for improved MH/SA treatment related to pharmaceutical innovations. We find that psychotropic medication costs continued to increase after the introduction of a substantial benefit expansion and carve-out to a managed behavioral health organization (MBHO), offsetting large declines in inpatient specialty MH/SA costs. However, we find evidence that the MBHO may have restrained growth in prescription medication spending.
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Affiliation(s)
- Samuel H Zuvekas
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA.
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Duffy FF, Narrow W, West JC, Fochtmann LJ, Kahn DA, Suppes T, Oldham JM, McIntyre JS, Manderscheid RW, Sirovatka P, Regier D. Quality of care measures for the treatment of bipolar disorder. Psychiatr Q 2005; 76:213-30. [PMID: 16080418 DOI: 10.1007/s11126-005-2975-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The staff of the American Psychiatric Association (APA), the American Psychiatric Institute for Research and Education (APIRE), and a national panel of experts in bipolar disorder and practice guideline development have collaborated to generate a set of quality of care indicators for the pharmacologic and psychosocial treatment of bipolar disorder. The indicators were derived from APA's evidence-based Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2002 (1) and the Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder, 2000 (2) These quality indicators can be used for quality monitoring, benchmarking, and quality improvement efforts across health plans, systems of care, and health care providers to improve quality and outcomes of care for patients with bipolar disorder.
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Affiliation(s)
- Farifteh Firoozmand Duffy
- American Psychiatric Institute for Research and Education, 1000 Wilson Blvd, Suite 1825, Arlington, Virginia 22209, USA.
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Druss BG, Marcus SC, Olfson M, Pincus HA. Listening to generic Prozac: winners, losers, and sideliners. Health Aff (Millwood) 2004; 23:210-6. [PMID: 15371387 DOI: 10.1377/hlthaff.23.5.210] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study tracks the diffusion of generic fluoxetine after its release in August 2001 within the largest U.S. pharmacy benefit manager (PBM). Within two weeks of the generic's release, prescriptions exceeded those of brand-name Prozac. The main winners proved to be Barr Laboratories, the first entrant to the generic market; large purchasers, who reaped substantial cost savings after Barr's period of exclusivity expired; and the PBM. The major loser was Eli Lilly, the manufacturer of Prozac. Consumers and makers of other antidepressants largely remained on the sidelines, with surprisingly little short-term impact evident from Prozac's patent expiration.
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