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

Ultimately, a pharmaceutical agent can only be used as often as physicians are willing to prescribe it. Therefore, physician preferences, perceptions, and prescribing habits play a significant role in determining the extent to which a new technology is utilized in the health care system. Factors that influence physician preference, perceptions, an

Under step care programs, physicians are required to attempt to treat a patient with a designated first-line drug and document treatment failure or patient intolerance prior to using another "reserved" agent. In general it is thought that the designated first-line drug is an older, often cheaper, and perhaps less effective drug than the reserved d

Prior authorization (PA) is a gatekeeping mechanism put in place in some health care programs whereby a patient or provider must obtain special approval prior to the dispensing of a particular set of drugs. Individuals within the health care payer organization approve or deny a particular prescription request based on a defined set of criteria. PA

The most basic drug formulary is a descriptive list of medications available in a given health care setting. Early formularies were lists of all medications available in a hospital pharmacy. Eventually, some formularies began to limit the availability of unlisted agents, thereby serving a regulatory function. These "restrictive" formularies have b

Benefit design is the primary mechanism that influences access to newer pharmaceuticals. Some health plans do not cover pharmaceutical benefits at all (e.g., Medicare), while others place restrictions on the number of prescriptions a given beneficiary may receive each month (e.g., several State Medicaid programs). Furthermore, coordination of bene

Evidence from the pharmacoeconomic literature shows that treatment using the new antipsychotics exhibits economic advantages over treatment using the older antipsychotics. This evidence for olanzapine and clozapine is superior to the corresponding evidence for risperidone. The results of numerous studies together provide strong evidence of cl

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