Facts on Access to Medications for People
with Depressive, Bipolar and Anxiety Illnesses
Restrictive Formularies are Bad Economics for States
Because of the characteristics of depressive, bipolar and anxiety disorders, and the uniqueness of medications that treat these illnesses, restrictive formularies are not likely to control costs as effectively as they control the costs for other chronic diseases, and could negatively affect the treatment-matching process, depending on formularies’ structures, (Soumerai, 2003 and 2004; Towse, 2003; Hensley, 2001; Horn, 2003).
Failure to treat moderate to severe forms of depressive, bipolar and anxiety disorders with the most effective and appropriate medications available results not only in incomplete recovery and potential relapse, but potentially in increasingly severe symptoms, leading to a patient’s death by suicide, (Figure 3).
People with depressive, bipolar and anxiety disorders are at high risk of attempted and completed suicide; however, they frequently return to work if they are adequately treated.
Denying access to needed medications ultimately increases costs to the state’s Medicaid system.
For example, if limits to one anti-depressant are imposed, about 25% of patients will not respond to that agent and will need to switch, resulting in a referral to a more costly psychiatry specialty sector or patient drop out. Patients who switch anti-depressants are in treatment 50% longer and cost approximately 50% more to treat in more costly treatment settings.
Denying access also increases costs in other areas through increased homelessness and incarceration. Jails and prisons have become the "de facto" psychiatric hospitals in the U.S., (Figure 4).
A study conducted by the University of Southern California found that "fail first" policies for psychiatric medications cost the state more than $2,500 per consumer in just a 6-month period.
A federally funded study conducted by The Lewin Group found that reductions in pharmaceutical budgets gained by excluding effective medications from coverage is more than offset by increases elsewhere in the system such as increased hospitalization and emergency room use.