Impact of Medicare Drug Coverage on Antidepressant Quality and Outcomes

描述（由申请人提供）：虽然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，并因处方药成本高而受到影响。新的医疗保险药物福利代表了一个前所未有的机会，以解决这些费用;然而，有巨大的压力，以控制支出的病人分担费用。药物治疗管理（MTM）计划也将由药剂师管理。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计划将如何影响抗抑郁药的使用，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评审意见后，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，以阐明以下医疗保险药物覆盖范围的影响： - 抗抑郁药使用的即时变化，包括重要亚组（例如，没有先前的药物覆盖）和时间段（例如，初始覆盖和灾难覆盖之间的“甜甜圈洞”）。 - 抗抑郁药处方质量的变化，以及是否有任何影响取决于所使用的药物费用分摊措施的类型？ - 对抗抑郁药使用者健康结局的影响，包括急诊、住院和入住疗养院的需求 - 对最脆弱的老年人亚群的影响，例如低收入、健康状况和功能差以及特定合并症的老年人。 - MTM项目对老年抗抑郁药使用者的有效性和成本效益 - 制定政策模拟程序，帮助政策制定者预测成本控制措施对使用抗抑郁药的老年人的影响 - 向联邦和州一级的决策者传播结果和建议。只有有了这些信息，才能进行必要的调整（例如，处方集，费用分摊和MTM计划），以提高易感和传统上服务不足的老年抑郁症患者的药物治疗质量和结果。

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.