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Medicare Part D coverage of antidepressants may limit treatment options

Patients’ access to affordable antidepressants may be limited due to last year’s changes to Medicare Part D, according to an analysis published in JAMA Psychiatry.

“We found that 76 percent of patients used only one drug throughout treatment,” Yuhua Bao, PhD, of the Department of Healthcare Policy and Research, Weill Cornell Medical College, in New York, said in a press release. “This suggests a disconnect between actual clinical practice and compelling scientific evidence of the benefits of at least two antidepressant drug trials for a vast majority of patients.”

Yuhua Bao

Researchers analyzed 2009 to 2010 data from a random sample of over 1 million fee-for-service Medicare enrollees in stand-alone Part D plan, including 47,214 patients who received a diagnosis of depression and began antidepressant treatment, according to data.

Their analysis sought to answer the following three questions:

• What proportion of Medicare patients try multiple antidepressants over the course of a treatment episode?
• Are some Part D plans imposing restrictions on antidepressants even if they are covered on the formulary?
• Does the number of unique antidepressants used per episode vary across plans that are more vs. less restrictive?

They found that 76% of patients who began antidepressant therapy for depression used only one antidepressant agent, 20% used two agents and 4% used more than two agents, according to data.

Bao and colleagues wrote that if this pattern continues, only 4% of Medicare patients will have their medication choices limited in the most restricted plans.

Some plans require prior authorization for certain antidepressants or prescribing the most cost-effective ones. Medicare patients were enrolled in plans that were applicable to these requirements for at least one antidepressant (52%) and almost always prescribed a brand-name drug, they wrote.

“Comprehensive drug coverage alone is not enough to improve the quality of depression management,” Bao said in the release. “Ultimately, better outcomes are achieved when doctors and patients work together throughout the course of treatment, which may include regular monitoring of a patient’s symptoms and response to medication and adjustment of their antidepressant regimens to maximize the benefits of treatment.”

Disclosure: The researchers report no relevant financial disclosures.