Medstat • MercuryMD • Micromedex • PDR • Solucient
Drugs for Treatment of Mental Illness:
Spending, Use, and Prescribing by Specialty
American Public Health Association Annual Meeting
November 5, 2007
2Medstat • MercuryMD • Micromedex • PDR • Solucient
AuthorsThomson Healthcare:
Katharine Levit Cheryl Kassed
Tami Mark Rosanna Coffey
SAMHSA:
Jeffrey Buck
3Medstat • MercuryMD • Micromedex • PDR • Solucient
Funding
Substance Abuse and Mental Health Services Administration
Views expressed are those of the authors and do not necessarily reflect those of SAMHSA or DHHS
4Medstat • MercuryMD • Micromedex • PDR • Solucient
Purpose of PresentationTo understand
• Types of drugs used to treat mental illness
• Factors influencing level and growth in MH drug spending
• Role of primary care physicians (PCPs) in prescribing MH medications
• Pros and cons of prescribing by PCPs
5Medstat • MercuryMD • Micromedex • PDR • Solucient
Background• Relatively stable prevalence of MH conditions
over past decade • More people getting MH treatment with
prescription medications• Prescription MH medications (2006)
– $37.8 billion in Rx spending– $1 out of every $6 spent on drugs
nationwide was for MH drugs– 458 million new and refilled Rx for
psychotherapeutics
6Medstat • MercuryMD • Micromedex • PDR • Solucient
Study Design
Estimates of retail pharmacy prescriptions:• IMS’ National Prescription Audit (NPA) PlusTM
database for 2002-2006– Sample from 36,000 retail pharmacies– Volume and cost of new and refilled
prescriptions used to treat mental illness– Physician specialty information assigned by
IMS (based on DEA #)
7Medstat • MercuryMD • Micromedex • PDR • Solucient
Study Design (cont’d)
Physician specialty categories:
• Psychiatric physicians
• Primary care physicians
• Nurse practitioners and physician assistants
• All other physician specialties
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Study Limitations• Excludes:
– Drugs dispensed by member-only HMO pharmacies, hospitals, and clinics
– Diagnoses related to prescriptions– Adjustments for dosage (number of pills or
medication strength)• New DEA number regulations allow physician
assistants and nurse practitioners to have own DEA number, which can skew recent physician specialty trends
9Medstat • MercuryMD • Micromedex • PDR • Solucient
Rx Spending in MH Treatment
$0
$10
$20
$30
$40
2002 2006
Sp
en
din
g in
Bill
ion
s
Anti-mania
Benzodiazepines
Stimulants(Analeptics)Anxiolytics/sedatives/hypnotics
Tranquilizers/anti-psychotics
Antidepressants
$37.8
$26.2
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Quantity Factor: No. of MH Rx Filled by Drug Type
7962
5234
4
227
0
50
100
150
200
250
2006
No
. of
Pre
sc
rip
tio
ns
in M
illio
ns
Antidepressants
Benzodiazepines
Anxiolytics/sedatives/hypnotics
Tranquilizers/anti-psychotics
Stimulants (Analeptics)
Anti-mania
11Medstat • MercuryMD • Micromedex • PDR • Solucient
Price Factor: Cost per Prescription by Rx Type
$69
$230
$69
$115
$24 $23
$0
$50
$100
$150
$200
$250
2006
Co
st p
er
Pre
scri
ptio
n (
$)
Antidepressants
Tranquilizers/anti-psychotics
Anxiolytics/sedatives/hypnotics
Stimulants(Analeptics)
Benzodiazepines
Anti-mania
12Medstat • MercuryMD • Micromedex • PDR • Solucient
Spending Growth: 2002 to 2006
84%85%
112%
-4%5%
15%
-20%
0%
20%
40%
60%
80%
100%
120%
Pe
rce
nt G
row
th
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Factors Affecting Spending Growth, 2002-2006
67%48%
36%
-7% -5%
45%
38%48%
15%
0%
15% 1%
-20%
0%
20%
40%
60%
80%
100%
120%
Stimulants (Analeptics)
Anxiolytics/sedatives/hypnotics
Tranquilizers/antipsychotics
Antidepressants
BenzodiazepinesAnti-mania
Per
cent
Gro
wth
No. of PrescriptionsPrice per Prescription
14Medstat • MercuryMD • Micromedex • PDR • Solucient
Spending for Rxs Used in MH Treatment• Spending grew from $26.2 billion in
2002 to $37.8 billion in 2006
• 44% increase in MH drug spending
– 52% due to increase in use
– 48% due to increase in cost per script
• Factors accounting for spending growth differed by drug type
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Distribution of MH Medications by Prescribing Physician Specialty
59%
23%
13%
5%
0
10
20
30
40
50
60
70
2006
Pe
rce
nt
Dis
trib
uti
on
-No
. of
Pre
sc
rip
tio
ns
GeneralistPhysicians
Mental Health andSubstance AbuseSpecialtiesAll Other PhysicianSpecialties
PhysicianAssistants andNurse Practitioners
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Growth in MH Medications by Prescribing Physician Specialty
10.7%
15.4%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
2003-2006
To
tal G
row
th (
Pe
rce
nt)
GeneralistPhysicians
Mental Health andSubstance AbuseSpecialties
17Medstat • MercuryMD • Micromedex • PDR • Solucient
Distribution of MH Prescriptions by Physician Specialty & Rx Type
13% 13%
21%
34%
49%
66%66%63% 62%
52%
37%
22%
0%
20%
40%
60%
80%
100%
Benzodiazepines
Anxiolytics/sedatives/hypnotics
Antidepressants
Stimulants (Analeptics)
Tranquilizers/antipsychotics
Anti-maniaPer
cen
t o
f P
resc
rip
tio
ns
by
Dru
g
Cat
ego
ry
Mental Health and Substance Abuse Specialties
Generalist Physicians
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Role of Physician Specialties in Prescribing MH Medications• 6 out of every 10 MH scripts are written by
primary care physicians (PCPs)• Growth in PCP MH prescribing was 50%
faster than that of MH specialist prescribing (2003-2006)
• PCPs prescribed a greater share of benzodiazepines, anxiolytics, antidepressants, and stimulants
• MH specialists prescribed a greater share of antipsychotics and antimanics
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Possible Pros & Cons of Primary Care Physician (PCP) Prescribing
• Patient Access
• Diagnosis and Treatment
• Training
• Insurance Incentives
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Possible Pros of PCP Prescribing: Patient Access
• PCPs may provide access to care in areas where MH professionals are in short supply
• PCPs may prescribe in conjunction with treatment by psychologists, counselors, or social workers (who cannot write prescriptions)
• Individuals may receive MH treatment in a setting that is comfortable (family doctor), avoid perceived stigma
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Possible Cons of PCP Prescribing: Diagnosis and Treatment
• PCPs may be less well trained to diagnose mental illness– Formal assessment instruments used
less often– Potential for under- or misdiagnosis
and inappropriate treatment• Shift in prescribing to PCPs can de-link
medication therapy from proven benefits of behavioral therapy
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Possible Cons of PCP Prescribing: Physician Training and Insurance Incentives• PCPs may be less knowledgeable
about MH medications and their side effects and effectiveness
• PCPs may not have the payment incentives to encourage routine monitoring of MH conditions in primary care settings
23Medstat • MercuryMD • Micromedex • PDR • Solucient
Contact Information
Katharine LevitSenior Research LeaderThomson Healthcare4301 Connecticut Avenue, NWSuite 330Washington, D. C. 20008Office: 202-719-7835E-mail:
Jeffrey Buck, PhDSurvey, Analysis, and Financing
BranchDivision of State and Community
Systems DevelopmentCenter for Mental Health ServicesSubstance Abuse and Mental Health
Services Administration 1 Choke Cherry RoadRockville, MD 20857Office: 240-276-1757E-mail: [email protected]