Medicare Part D Gap Lowers Maintenance Antidepressant Use

Elderly with generic coverage reduce just their use of brand-name antidepressants

FRIDAY, July 6 (HealthDay News) -- The Medicare Part D coverage gap correlates with modest reductions in the use of antidepressants among older adults, which are similar to the reduction in prescriptions for heart failure and diabetes medications, according to a study published in the July issue of the Archives of General Psychiatry.

Yuting Zhang, Ph.D., from the University of Pittsburgh in Pennsylvania, and colleagues conducted an observational before-after study involving a 5 percent random sample of U.S. Medicare beneficiaries (65 years or older) with depression (65,223 participants) enrolled in stand-alone Part D plans.

The researchers found that the coverage gap was associated with comparable reductions in the use of antidepressants, heart failure medications, and antidiabetics. The no-coverage group lowered their monthly antidepressant prescriptions by 12.1 percent from the pregap level, with reductions of 12.9 percent for the use of heart failure drugs and 13.4 percent for antidiabetics, compared to those with full coverage in the gap. The monthly reduction in antidepressant prescriptions was 6.9 percent for those with generic drug coverage in the gap, with the decreased prescription rate entirely attributable to the reduction in the use of brand-name antidepressants. Relative to the comparison group, there was no increase in either group in Medicare spending on medical care.

"Compared with the overall elderly Medicare population, the magnitude of the coverage gap effects among elderly beneficiaries with depression is similar," the authors write. "If patients discontinue their appropriate medication therapy abruptly, they could be placing themselves at risk for medication withdrawal effects and for relapse or recurrence."

Several authors disclosed financial ties to the pharmaceutical industry and to Highmark Inc., which sells part D products.

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