Management of access to branded psychotropic medications in private health plans.
BACKGROUND
In the past decade, health insurers have increased their reliance on cost control policies such as prior authorization and 3-tier formularies. Little is known about how these policies are being applied to psychotropic medications, many of which have low rates of patient adherence.


OBJECTIVE
This study reports on plans' cost-sharing tier placement and authorization policies for 12 brand only psychotropic medications in 3 classes: antidepressants, anti-psychotics, and medications for attention deficit/hyperactivity disorder (ADFID).


METHODS
Data were from a nationally representative survey of private health plans regarding mental health and substance-abuse services in 2003; 368 plans responded (83% response rate). Results were weighted and represent national estimates of health-plan characteristics.


RESULTS
The majority of insurance products provided unrestricted placement on Tier 2 (medium copayment) for at least 2 brand-only antidepressants and at least 2 brand-only antipsychotics. This approach allows clinicians some limited leeway in initial medication selection. However, most patients who did not respond to the Tier-2 options typically faced a substantial escalation in copayment (Tier 3), possibly leading to premature medication discontinuation. For ADHI)5 the options were considerably more limited, with 22.1% of products applying some restriction to all 3 medications and only 15.9% of products leaving all 3 medications unrestricted. Plans with specialty contracts for mental health were considerably more likely to use Tier 3 (highest copayment) as their only restriction approach.


CONCLUSIONS
Based on the results of this analysis,private plans were managing psychotropic costs using copayment incentives rather than administrative controls. This approach was less intrusive for clinicians, but resulting higher copayments could worsen already high rates of nonadherence; future research should examine this issue.
Hodgkin
Dominic
D
Institute for Behavioral Health, Schneider Institutes, Heller School of Social Policy and Management,Brandeis University, Waltham, Massachusetts 02454-9110, USA. hodgkin@brandeis.edu
Horgan
Constance M
CM
Garnick
Deborah W
DW
Len Merrick
Elizabeth
E
Volpe-Vartanian
Joanna
J
D000928:Antidepressive Agents / Q000191:economics; D014150:Antipsychotic Agents / Q000191:economics; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D017047:Cost Sharing; D003625:Data Collection; D016527:Drug Costs; D016568:Drugs, Generic; D005569:Formularies as Topic; D006297:Health Services Accessibility / Q000191:economics*; D006306:Health Surveys; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics; D015233:Models, Statistical; D010349:Patient Compliance; D017149:Private Sector; D011619:Psychotropic Drugs / Q000191:economics* / Q000627:therapeutic use
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D016568:Drugs, Generic; D011619:Psychotropic Drugs