title: Impact of Medicare Part D on antidepressant treatment, medication choice, and adherence among older adults with depression.
abstract: OBJECTIVE
  Depression in older adults is often undertreated due, in part, to medication costs. We examined the impact of improved prescription drug coverage under Medicare Part D on use of antidepressants, medication choice, and adherence.
  
  
  METHODS
  Observational claims-based study of older adults with depression (ICD-9: 296.2, 296.3, 311, 300.4) continuously enrolled in a Medicare managed care plan between 2004 and 2007. Three groups with limited ($150 or $350 quarterly caps) or no drug coverage in 2004-2005 obtained Part D benefits in 2006. A comparison group had stable employer-sponsored coverage throughout.
  
  
  METHODS
  Any antidepressant prescription fill, antidepressant choice (tricyclics or monoamine oxidase inhibitors versus newer antidepressants), and adherence (80% of days covered) in the first 6 months of treatment.
  
  
  RESULTS
  : Part D was associated with increased odds of any antidepressant use among those who previously lacked coverage (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.41-1.85) but odds of use did not change among those with limited prior coverage. Use of older antidepressant agents did not change with Part D. All three groups whose coverage improved with Part D had significantly higher odds of 80% of days covered with an antidepressant (OR = 1.86 [95% CI: 1.44-2.39] for no coverage, 1.74 [95% CI: 1.25%3.42] for $150 cap; and 1.19 [95% CI: 1.06-1.34] for the $350 cap groups).
  
  
  CONCLUSIONS
  Medicare Part D was associated with improvements in antidepressant use and adherence in depressed older adults who previously had no or limited drug coverage but not with changes in use of older agents. use and adherence in depressed older adults who previously had no or limited drug coverage but not with changes in use of older agents.
authors: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. jdonohue@pitt.edu
authors: Julie M
authors: JM
authors: Donohue
authors: Yuting
authors: Y
authors: Zhang
authors: Men
authors: M
authors: Aiju
authors: Subashan
authors: S
authors: Perera
authors: Judith R
authors: JR
authors: Lave
authors: Joseph T
authors: JT
authors: Hanlon
authors: Charles F
authors: CF
authors: Reynolds
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000191:economics / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D054524:Medicare Part D; D054539:Medication Therapy Management / Q000191:economics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States; D016903:Drug Monitoring
chemical_list: D000928:Antidepressive Agents