title: Developing a policy for second-generation antipsychotic drugs.
abstract: Second-generation antipsychotics (SGAs) have replaced older drugs in the treatment of schizophrenia; their costs in the United States have reached $13 billion a year. Recent research, however, shows that their net risk/benefit profiles are no better than some older, cheaper drugs. Stepped therapy, allowing exceptions with prior authorization and giving preference to generic drugs with low risk of both neurologic and metabolic side effects, could increase the cost-effectiveness and safety of antipsychotic drugs. Educational preparation and monitoring of adverse events would foster better acceptance of such procedures among providers, patients, and families. Research to evaluate these interventions would ideally precede their widespread implementation.
authors.affiliation: New England Mental Illness Research, Education, and Clinical Center, Veterans Affairs (VA) Connecticut Health Care System, West Haven, Connecticut, USA. robert.rosenheck@yale.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sernyak
mesh_terms: D014150:Antipsychotic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D057186:Comparative Effectiveness Research; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D006291:Health Policy; D006801:Humans; D012559:Schizophrenia / Q000188:drug therapy*; D014481:United States
chemical_list: D014150:Antipsychotic Agents