The Effects of Antidepressant Step Therapy Protocols on Pharmaceutical and Medical Utilization and Expenditures

Abstract

Step therapy may have the unintended effect of reducing overall antidepressant use and increasing medical use and costs.

Pharmaceutical Step-Therapy Interventions: A Critical Review of the Literature

“…25 Mark et al (2009) examined total prescription drug expenditures for antihypertensive users (i.e., not just antihypertensive spend) and reported that overall prescription drug spending initially declined 3.1% after program implementation, but the savings did diminish somewhat over time. 12 The authors did not report changes in antihypertensive drug spending. Motheral et al (2004) found drug savings of $0.93 PMPM following implementation of an ST program for PPIs, NSAIDs, and selective serotonin reuptake inhibitors (SSRIs).…”

“…[8][9][10] ■■ Results Fourteen evaluations of ST programs have been published to date. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Seven of the studies were conducted in commercial populations (Table 1), while 7 assessed Medicaid ST programs (Table 2). An analysis by Panzer et al (2005) was an economic model of an antidepressant ST program for patients with anxiety, 15 and Cox et al (2004) surveyed members with an ST edit/ reject to assess their responses to the edit.…”

“…24 Accordingly, other than studies of antipsychotics within Medicaid populations, the only studies that have not found sustained drug savings from ST are those that examined total prescription drug costs for patients enrolled in ST rather than disease-specific drug costs. 11,12 Research shows that drug cost savings result from greater use of first-line medications and also from less medication use as evidenced in the claims data. Using patient self-report, Motheral et al found that 17% of patients received no medication after the ST edit, and 16% paid full price for the brand medication.…”

“…17 In both studies, the percentage of patients receiving no medication was highest for PPIs. Yokoyama 15 Also looking at antidepressants, Mark et al (2010) reported an initial savings of 1.7% across total prescription drug costs (not just antidepressant spend) but found that the savings diminished over time. 11 The authors did not report expenditures for antidepressant medications.…”

“…Mark et al reported higher allcause inpatient, ER, and outpatient expenditures after implementation of an ST program for antidepressants, adjusting for baseline differences in costs and demographics. 11 However, the authors failed to report baseline medical utilization or spending to allow for assessment of the comparability of the 2 groups. Calculation of unadjusted average all-cause medical and pharmacy costs showed an average $1,967 annual cost per patient for ST plans in the year after implementation of ST (2006), 6.9% lower than the average for the comparison plans without ST for antidepressants.…”