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Exchange Plans, Medicaid Expansion Will Boost Access to Drugs for Major Depression, Bipolar Disorder and Schizophrenia

Facing Higher Costs, MCOs Will Push for Lower-Cost Treatments, According to Findings from Decision Resources Group

BURLINGTON, Mass., Sept. 3, 2014 /PRNewswire/ -- Decision Resources Group finds that surveyed managed care organizations (MCOs), psychiatrists and primary care physicians (PCPs) anticipate a significant increase in demand for drugs treating major depression, bipolar disorder and schizophrenia, owing to the expansion of Medicaid (in 24 states) and the availability of affordable coverage through the Affordable Care Act (ACA) exchanges. Among 72 surveyed psychologists, respondents expected to treat 14 percent more patients with these three indications, on average, because of coverage expansion through the ACA exchange plans and Medicaid expansion. Among 72 surveyed PCPs, the expected increase is much greater: 30 percent more patients with these conditions are expected. The 44 surveyed medical directors and pharmacy directors of MCOs indicate that the drug formularies found within the new exchange-based health plans are the same formulary or compare favorably with those of traditional group health plans. While drug classes used to treat these behavioral health conditions are widely populated with generics, MCOs offer favorable tier placement to some brands they believe to offer superior efficacy, safety and tolerability.

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Other key findings from the U.S. Physician & Payer Forum report entitled Healthcare Reform and Behavioral Health: Impact of Health Exchanges and Medicaid Expansion on Prescribing for Schizophrenia, Major Depression, and Bipolar Disorder:

  • Drug compliance: When asked to rank the most important considerations in prescribing specific drugs for behavioral disorders, surveyed psychologists and PCPs ranked patient compliance with therapy as the most important factor in prescribing.
  • Formulary placement: MCO respondents report that branded behavioral drugs such as Takeda's Brintellix, Actavis's Saphris and Novartis's Fanapt are excluded less often from exchange plans than from commercial group plans.
  • Continued demand for patient assistance programs: Surveyed PCPs and psychologists overwhelmingly support pharmaceutical companies' patient assistant programs (PAPs) and believe they will still need drug coupons for their exchange plan patients whose high deductibles or formulary exclusions are barriers.
  • Abilify: Bristol-Myers Squibb/Otsuka's Abilify is broadly used for all three indications tested here, with tier 1 or tier 2 placement in most commercial plans, on or off the exchange. Its scheduled generic launch in 2015 will likely increase its utilization, especially within Medicaid plans and in those plans where MCOs offer higher payments for physicians with high generic prescribing rates.

Comments from Decision Resources Group Principal Analyst Paula Wade:

  • "The utilization of narrow provider networks in exchange-based plans will send large numbers of new patients to primary care physicians seeking treatment for behavioral health conditions. These generalists are less familiar with the newer branded agents than psychiatrists are and might welcome additional information regarding PAPs."

About Decision Resources Group
Decision Resources Group offers best-in-class, high-value information and insights on critical issues within the healthcare industry. Clients rely on this analysis and data to make informed decisions. Find out more at www.DecisionResourcesGroup.com.

All company, brand, or product names contained in this document may be trademarks or
registered trademarks of their respective holders.

For more information, contact:

Decision Resources Group
Christopher Comfort
781-993-2597
[email protected]

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SOURCE Decision Resources Group

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