The Effect of Managed Care on the Diffusion of Psychotropic Medications
- Presenter:
Mon June 5, 2006 9:30-10:45 Room Alumni Lounge
Background: The last decade has witnessed unprecedented growth in new technologies in mental health treatment. The availability of new pharmacological agents has had an enormous impact on the treatment of mental health disorders, enabling recipients of these medications to experience relief of many symptoms and improve their levels of functioning and quality of life. The diffusion of these new behavioral health technologies, or rate at which these products have spread through the market, has been very uneven. Some psychotropic medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs), now considered first line treatments for depression, have diffused very quickly, while others, such as venlafaxine, also a treatment for depression with equal efficacy have not had much success developing a substantial market share. In order to advance models of best practice, it is important to understand the factors that underlie these varying rates of diffusion. Differences in adoptions and diffusion rates of psychotropic medications across insurance settings, geographic regions, or subpopulations defined by age, gender, or racial or ethic groups has important implications for the quality of care received by persons with mental illnesses. As the tools of managed care increasingly penetrate behavioral health insurance, the diffusion of new psychotropic products into existing treatment options is likely to be strongly affected. The direction of this effect is ambiguous due to the complexity and differing incentives inherent in these tools.
Objectives: The purpose of this paper is to examine whether managed care penetration is associated with different rates of psychotropic drug diffusion in fee-for-service Medicaid programs.
Methodology: Data on all psychotropic medications reimbursed through fee-for-service Medicaid programs in almost all states (n=49) in the US were obtained from 1991-2003. Prescriptions were converted to daily dose units in order to pool information from medication classes. Two of the major classes of psychotropic medications, antidepressants and antipsychotics were examined separately. State-level fixed effect regressions were run on the dependent variable of daily dose units, with state-level Medicaid managed care penetration as the explanatory variable of interest. Diffusion curves were also modeled using a classic logit framework as well as with hyperbolic secant function.
Results: Results indicate a negative association between the managed care penetration level in a state and the number of daily dose units of psychotropic medication filled.
Conclusion: Although managed care emphasizes outpatient treatment over more costly inpatient care, the tools used by many managed care programs, including prior authorization and drug formularies may delay the receipt of treatments and these effects may be spilling over to non-managed settings. Further research to examine this effect is warranted.
