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. ? ? ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01MH079175-01A1
Application #
7317262
Study Section
Mental Health Services in MH Specialty Settings (SRSP)
Program Officer
Evans, Jovier D
Project Start
2007-08-29
Project End
2011-06-30
Budget Start
2007-08-29
Budget End
2008-06-30
Support Year
1
Fiscal Year
2007
Total Cost
$393,750
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Polinski, Jennifer M; Brookhart, M Alan; Glynn, Robert J et al. (2012) Medicare part D's impact on antipsychotic drug use and costs among elderly patients without prior drug insurance. J Clin Psychopharmacol 32:3-10
Polinski, Jennifer M; Shrank, William H; Glynn, Robert J et al. (2012) Association between the Part D coverage gap and adverse health outcomes. J Am Geriatr Soc 60:1408-17
Polinski, Jennifer M; Schneeweiss, Sebastian; Glynn, Robert J et al. (2012) Confronting ""confounding by health system use"" in Medicare Part D: comparative effectiveness of propensity score approaches to confounding adjustment. Pharmacoepidemiol Drug Saf 21 Suppl 2:90-8
Polinski, Jennifer M; Shrank, William H; Glynn, Robert J et al. (2012) Beneficiaries with cardiovascular disease and thePart D coverage gap. Circ Cardiovasc Qual Outcomes 5:387-95
Polinski, Jennifer M; Donohue, Julie M; Kilabuk, Elaine et al. (2011) Medicare Part D's effect on the under- and overuse of medications: a systematic review. J Am Geriatr Soc 59:1922-33
Polinski, Jennifer M; Shrank, William H; Huskamp, Haiden A et al. (2011) Changes in drug utilization during a gap in insurance coverage: an examination of the medicare Part D coverage gap. PLoS Med 8:e1001075
Polinski, Jennifer M; Bhandari, Aman; Saya, Uzaib Y et al. (2010) Medicare beneficiaries' knowledge of and choices regarding Part D, 2005 to the present. J Am Geriatr Soc 58:950-66
Polinski, Jennifer M; Kilabuk, Elaine; Schneeweiss, Sebastian et al. (2010) Changes in drug use and out-of-pocket costs associated with Medicare Part D implementation: a systematic review. J Am Geriatr Soc 58:1764-79
Schneeweiss, Sebastian; Patrick, Amanda R; Pedan, Alex et al. (2009) The effect of Medicare Part D coverage on drug use and cost sharing among seniors without prior drug benefits. Health Aff (Millwood) 28:w305-16
Polinski, Jennifer M; Schneeweiss, Sebastian; Levin, Raisa et al. (2009) Completeness of retail pharmacy claims data: implications for pharmacoepidemiologic studies and pharmacy practice in elderly patients. Clin Ther 31:2048-59

Showing the most recent 10 out of 11 publications