Access and Utilization of New Antidepressant and Antipsychotic Medications. Chapter V. The Current State of Antidepressant and Antipsychotic Utilization


Although newer antidepressant and antipsychotic medications were much more readily available to health care consumers in 1999 than they were when first introduced, health care payers have been less aggressive at promoting appropriate use than they had been at discouraging inappropriate use. Primary research indicated few cases where payers have implemented processes and procedures to insure appropriate prescribing and dosing, detection of mental illness, reimbursement, or patient compliance with care. These programs appear to be in their infancy, with many respondents indicating that their programs were relatively new. In this section, we report on the status of utilization as assessed in our research.

In summary, this study found:

Health care payers have not been active in designing treatment algorithms or comparing the effectiveness of competing agents head to head.

  • The treatment algorithms that do exist largely give general guidance to the clinician and leave choice of individual agents and precise dosage to the clinician.
  • Treatment algorithms are more common in closed systems such as group model HMOs and payers such as DoD or the VA.
  • The paucity of specific guidance reflects the lack of consensus as to which of the newer agents is superior and for whom.

Clinical development and marketing decisions affect the utilization of any pharmaceutical agent. However the impact of marketing strategies on utilization has not been assessed in any systematic way.

Most payers use some form of utilization review mechanism to track the utilization of psychotherapeutics.

  • These programs are applied to any drug class that may represent a large proportion of spending.
  • The goal of these programs is to track duplication, overuse, underuse, and possible drug interactions.

Payers are more likely to monitor providers for compliance with formularies or protocols than they are to monitor consumers for compliance with therapy.