NEW YORK (Reuters Health) – Contrary to expectations, antidepressant step therapy protocols appear to increase medical resource use and costs, according to a study conducted by Thomson Reuters under a contract from Pfizer, Inc.
As reported in the American Journal of Psychiatry published online August 16, Dr. Tami L. Mark with Thomson Reuters in Washington, DC, and colleagues investigated the effects of step therapy for antidepressants on prescription drug use, other medical utilization and spending.
“Managed care organizations and insurance plans are increasingly adopting step therapy in an effort to contain costs by steering patients away from more costly pharmacotherapies,” the team explains. Patients are required to try a first-line agent, usually a relatively inexpensive generic drug, before going on to a second-line agent, usually a brand-name product.
The investigators compared data on antidepressant users in plans that implemented step therapy with those in plans that had not implemented step therapy, based on statistics in the 2003-2006 Thomson Reuters MarketScan claims databases.
Days of antidepressant use upon initiating the step therapy plans was 3.9% lower than in the nonstep plans, the team found. However, this difference disappeared after a year.
Furthermore, mental health-related resource utilization increased. “Specifically, in the quarter immediately following step therapy implementation, the number of mental health-related outpatient visits was 19% higher, the number of mental health-related inpatient admissions was 21% higher, and the number of mental health-related emergency room visits was 18% higher.”
This resulted in similarly higher medical costs with step therapy compared with nonstep protocols.
“Clearly,” Dr. Mark and colleagues conclude, “there is a need for additional research to understand both the strengths and limitations of step therapy as a cost saving tool.”
Meanwhile, there are implications for patient care, Dr. Mark added in an email to Reuters Health. “The findings highlight that physicians need to be aware that many of their patients may have insurance benefits that are subject to step therapy and, as a result, patients may not always be able to easily fill the prescription that a physician writes. This may lead to negative consequences for their patients, such as worse medical outcomes,” she pointed out.
“Of course,” Dr. Mark added, “ideally insurance companies should also work to minimize the disruptions that step therapy may have on patient access to medications because they may be counter-productive from the perspective of a patient’s health and from a cost perspective”
Reference:
The Effects of Antidepressant Step Therapy Protocols on Pharmaceutical and Medical Utilization and Expenditures
Am J Psychiatry 2010
