Restricting drug choice can hinder recovery
Depressed patients do better when given choices
Health maintenance organizations (HMOs) that limit coverage of antidepressant drug therapy to a single medication may find that their members fail to complete their course of treatment, according to researchers at the University of Southern California School of Pharmacy in Los Angeles.
Researchers examined prescription drug and medical record data for 187 patients taking selective serotonin reuptake inhibitors (SSRIs) in a single group practice of primary care physicians. The group practice contracted with two HMOs that had different SSRI formulary restrictions.
One HMO limited coverage to paroxetine. The other HMO provided coverage for both paroxetine and fluoxetine.
Findings include the following:
• Patients limited to paroxetine alone were 80% less likely to complete therapy for clinical depression than patients given a choice of more than one SSRI.
• Patients treated with paroxetine were 64% less likely to complete treatment than patients treated with fluoxetine.
• Patients treated with the antidepressant setraline were 68% less likely to complete therapy than those on fluoxetine.
Don’t limit options
"These findings are important because limiting antidepressant options to a single agent appears to hinder completion rates," says Jeffrey S. McCombs, PhD, associate professor of pharmaceutical economics and policy at the University of Southern California and one of the study’s authors.
"Important clinical factors are often overlooked in the formulary decision process," explains McCombs. "Some HMOs capitate physician groups for the cost of ambulatory care, so patients’ increased use of office visits due to their premature termination of antidepressant therapy does not directly increase HMOs’ operating costs.
"This leads to formulary decisions being made solely on the basis of the cost of a drug or the size of the rebate that drug manufacturers pay directly to the HMO."
Nearly 75% of Americans who seek help for clinical depression or symptoms of depression go to a primary care physician for treatment, he adds.
"The newer SSRI antidepressants have significantly improved the ability of the primary care physician to treat depressed patients effectively, assuming that a range of treatment alternatives are available," he says.
(See also: Streja DA, Hui RL, Streja E, McCombs JS. Selective contracting and patient outcomes: A case study of formulary restrictions for selective serotonin reuptake inhibitor antidepressants. Am J Man Care 1999; 5:1,133-1,142.)
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