Impact of Medicare Drug Coverage on Antidepressant Quality and Outcomes

描述（由申请人提供）：尽管抗抑郁药是治疗老年抑郁症的主要药物，但治疗方案往往存在问题，并且由于高昂的处方药成本而受到损害。新的医疗保险药物福利为解决这些成本提供了前所未有的机会；然而，通过病人分担费用来控制开支的压力很大。药物治疗管理（MTM）项目也将由药剂师管理。目前尚不清楚这些药物覆盖范围的变化、成本控制策略和MTM计划将如何影响极度脆弱的老年抑郁症患者的抗抑郁药使用、质量、健康和经济结果。在仔细考虑了我们第一次提交的所有审稿人的意见后，我们提出了一种多方面的方法，使用几个大型代表性数据库的受控时间序列分析，来阐明以下医疗保险药物覆盖的影响：

DESCRIPTION (provided by applicant): Although antidepressants are the mainstay of treatment for depressed elderly, regimens are often problematic and undermined by high prescription drug costs. The new Medicare drug benefit represents an unprecedented opportunity to address these costs; however there are enormous pressures to contain expenditures by patient cost-sharing. Medication Therapy Management (MTM) programs will also be administered by pharmacists. It is unclear how these drug coverage changes, cost-containment strategies, and MTM programs will impact antidepressant use, quality, health, and economic outcomes in extremely vulnerable elderly with depression. After careful consideration of all reviewer comments of our first submission, we propose a multi-faceted approach using controlled time-series analyses of several large, representative databases, to shed light on the following Medicare drug coverage impacts: - Immediate changes in antidepressant use, including in important subgroups (e.g., with no prior drug coverage) and time periods (e.g., "Doughnut Holes" between initial coverage and catastrophic coverage). - Changes in antidepressant prescribing quality and whether any impacts differ depending upon the type of drug cost-sharing measures used? - Impacts on health outcomes experienced by antidepressant users, including the need for emergency care, hospitalizations, and nursing home admissions - Impacts on the most vulnerable elderly subgroups, such as those with low incomes, poor health status and functioning, and specific comorbidities. - Effectiveness and cost-effectiveness of MTM programs on elderly antidepressant users - Development of a policy simulation program to help policy makers predict the impacts of cost- containment measures on seniors who use antidepressants - Dissemination of results and recommendations to policy makers at the federal and state levels. Only with such information can necessary adaptations (e.g., to formulary, cost-sharing, and MTM programs) be made to improve the quality and outcomes of pharmacotherapies in susceptible and traditionally under-served elderly with depression.