Access and Utilization of New Antidepressant and Antipsychotic Medications. Utilization of Antidepressants

01/01/2000

In 1998, 62% of antidepressant prescriptions were for new-generation, branded antidepressants.

  • Medicaid programs in 45 States paid for over 19 million prescriptions for antidepressants.
    • The selective serotonin reuptake inhibitors (SSRIs) comprised 48% of total antidepressant prescriptions in 1998.
      • Prescriptions for the three leading agents (fluoxetine, paroxetine, and sertraline) were nearly equal with approximately 3 million prescriptions each, or a 15-16% share each.
    • Tricyclic antidepressants accounted for 27% of total prescriptions
    • The four other new generation antidepressants (bupropion, mirtazapine, nefazadone, and venlafaxine) together accounted for 14% of prescriptions.
  • In 1998, Medicaid expenditures on antidepressants in these 45 States reached nearly 1 billion dollars ($985 million).
    • Together, fluoxetine, sertraline and paroxetine comprised over 70% of all Medicaid spending on antidepressant drugs in 1998 ($711 million).
      • Fluoxetine accounted for 30% ($288 million) of all Medicaid spending for antidepressants in 1998.
      • Spending for sertraline reached only $214 million (23% of all Medicaid dollars reimbursed for antidepressants in 1998).
      • Dollars spent on paroxetine comprised only $199 million (20% of all Medicaid dollars spent on antidepressants in 1998).
    • TCAs accounted for only 5% of all Medicaid dollars reimbursed for antidepressants ($54 million).
    • Other new antidepressants bupropion, venlafaxine, nefazadone, and mirtazapine together accounted for expenditures of approximately $173 million or 18% of total expenditures.

The use of new-generation antidepressants in Medicaid grew dramatically between 1995 and 1998. As with antipsychotics, the growth in use of newer antidepressants rapidly outpaced the replacement of older agents.

  • Prescriptions for antidepressants increased from 13.7 million in 1995 to 19.3 million in 1998, an increase of over 40%.
    • Sertraline prescriptions increased from just over 2 million in 1995 to just over 3 million in 1998.
    • Fluoxetine prescriptions increased from just over 2 million in 1995 to just fewer than 3 million in 1998.
    • Paroxetine prescriptions increased from 1.2 million in 1995 to 2.9 million in 1998, an increase of 130%.
    • Prescriptions for TCAs fell from 6 million prescriptions in 1995 to 5 million in 1998 -- a 20% decrease.

Medicaid expenditures for antidepressants outpaced the rate of growth in number of prescriptions between 1995 and 1998.

  • Total expenditures increased from $500 million in 1995 to $985 million in 1998--an average increase of 25% per year, and an overall increase of 96%.
    • Much of this increase can be attributed to the steady, yet significant rise of the three leading SSRI antidepressants.
      • Expenditures for paroxetine increased nearly three-fold (an increase of $128 million over four years.
      • Expenditures for fluoxetine increased 73% ($120 million).
      • Expenditures for sertraline increased 64% ($84 million).
      • Expenditures for TCAs fell from $77 million in 1995 to $54 million in 1998.