Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111655

Dominic Hodgkin, PhD¹, Constance M. Horgan, ScD², Deborah Garnick, ScD², Elizabeth L. Merrick, PhD, MSW, and Joanna Volpe-Vartanian, MS, LICSW⁴. (1) Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, 781-736-8551, hodgkin@brandeis.edu, (2) Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, (3) Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 35,415 South St, Waltham, MA 02454

In recent years, many US health plans have introduced policies intended to control medication costs, including costs of psychopharmaceuticals. These policies include coverage exclusions, prior authorization requirements, restrictions on first line use, and placing selected drugs on a 'non-preferred' cost-sharing tier with substantially higher copayments. These policies could potentially have important effects on patients medication use and health outcomes. Our study documents the extent and stringency of private health plans' management of psychotropic drug use, and relates these to plan characteristics, such as plan size and pharmacy contracting arrangement. We surveyed 368 commercial health plans in 60 US market areas regarding administrative and clinical aspects of behavioral health care delivery, yielding national estimates of plan features in 2003 (83% response rate). We asked how they covered 28 psychotropic medications, including cost-sharing tier placement and what restrictions applied. We focus on the newest drugs in three psychotropic drug classes: antidepressants, anti-psychotics and drugs for attention-deficit hyperactivity disorder. 84% of plans use formularies with 3 or more tiers, with non-preferred medications placed on the costliest tier. Plans rarely exclude newer psychotropic medications altogether, and <10% of plans apply prior authorization and first-line restrictions. Placement on a non-preferred tier is the most common type of restriction. 47% of plans place 2 or more newer antidepressants on the non-preferred tier, and slightly fewer plans do so for newer antipsychotics and ADHD drugs. To understand privately insured patients' access to behavioral healthcare, one must examine formularies, and which drugs are assigned to which cost-sharing tiers.

Learning Objectives: After this session, participants will be able to

1.Distinguish the various approaches health plans use to influence utilization of prescription drugs
• Understand the way these approaches are applied to psychotropic medications.
• Describe the extent to which each psychotropic drug class is affected by each approach, in commercial health plans.

Keywords: Managed Care, Drugs

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation