Content by Keyword: Substance Abuse (Alcohol and Drug Abuse)

Published cost-effectiveness literature shows no clear differences in total treatment costs associated with the use of different antidepressant agents, although individual studies have claimed that one particular agent is superior to another.

New-generation antidepressants and antipsychotics have been accepted into common use by Medicaid programs at about the same rate and to the same extent as other innovator drugs. Newer antipsychotics appear to be proportionally more expensive than other new generation pharmaceuticals such as oral antidiabetics. Newer antidepressants appear to

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

In 1998, 51% of all Medicaid prescriptions for antipsychotics were for atypical antipsychotics. Expenditures on atypicals accounted for 89% of total spending on antipsychotics.

Programs that monitor patients for compliance with therapy or providers for compliance with treatment guidelines are in their infancy.

All of the payers interviewed maintain some form of drug utilization review (DUR) program. Most payers use DUR as an educational tool to encourage good prescribing practices. Several payers use DUR as a monitoring tool to enforce compliance with formulary, PA and treatment guidelines. Monitoring of psychotropic medications occurs no dif

Manufacturers express no bias against developing a new drug for mental health indications in comparison with physical health indications.

HCFA(now known as CMS) does not instruct States on the choice of appropriate medications for use in specific illnesses. However, HCFA(now known as CMS) did request that States make atypical antipsychotics available for first-line treatment of schizophrenia if requested by physicians. State Medicaid and State Mental Health programs have not wi

Traditional step care protocols, whereby patients are required to try an older generation agent prior to obtaining approval for reimbursement of a newer one, have largely disappeared. Currently, it is more common for payers to designate one or two preferred pharmaceuticals chosen from the newer agents. Patients must first experience a treatme

Provider and consumer associations interviewed report that prior authorization and paperwork requirements are now the primary barrier to access.

Manufacturers, providers and consumers concur that formularies are no longer restricting access to newer psychotherapeutic agents

Pharmaceutical benefits are commonly available for psychotherapeutic agents.

The Lewin Group identified a set of key topics and issues that affect access to and utilization of antidepressant and antipsychotic medications that were not adequately discussed in the literature. These topics included, but were not restricted to:

Quarterly, state level data on prescription drug utilization are available from the Health Care Financing Administration(now known as Centers for Medicare and Medicaid Services(CMS)) (HCFA(now known as CMS)). These data are reported at the National Drug Code (NDC) level, allowing analysis of utilization of individual pharmaceutical agents within t

Several individual searches of the databases MEDLINE and HEALTHSTAR were conducted in August 1999. All searches were limited to human subjects and English language. Cost studies were restricted to studies conducted in the United States, unless no studies for that agent were available. In this case, selected studies conducted in Europe or Canada we

Based on previous reports and the 1998 trend analysis, a number of issues and factors had been identified that were used as an initial starting point to organize this research. The cost of newer medications has clearly been identified as a key issue. The increased costs associated with the development and use of the newer antidepressants and antip

The antidepressants and antipsychotics of interest to this study are shown Exhibits I-1 and I-2, respectively, by generic and brand names. The principal antidepressants considered in this study include the Selective Serotonin Reupatke Inhibitors (SSRIs) and other newer antidepressants including venlafaxine, bupropion, nefazadone, and mirtazapine.

Utilization is defined as the use of a health care service, procedure, device, or pharmaceutical. Utilization is influenced by access, although the actual utilization of a given pharmaceutical may not reach the maximum level expected given a specified level of "access." Utilization can be recorded in a number of ways: per capita, hospital length o

Simply stated, "Access" to a particular health care service may be defined as the set of factors that affect the  potential  ability of an individual or a group to acquire timely and appropriate use of that service. Traditionally, access to health care services has been limited by race, gender, age, and class. 7  These factors cannot be control

The United States Department of Health and Human Services charged The Lewin Group with the task of elucidating the mechanisms that affect the extent to which Americans receive the most up-to-date pharmacotherapies for the treatment of mental illness. In examining this problem, we determined that this question is made up of two separate components