Before You Increase That Dose, Check Past Use: Medco Study

Before upping the dose of an antidepressant, doctors may want to ask how often patients actually take their current prescriptions.

That?s the suggestion of a new study from big pharmacy-benefit manager Medco Health Solutions, presented Thursday at an American Psychiatric Association meeting. Researchers from the company’s research affiliate, the Cleveland Clinic and the Scottsdale Center for the Advancement of Neuroscience looked at 53,530 patients in Medco?s prescription database who had gotten their antidepressant doses increased. Then they examined how consistently those people had been taking their earlier, lower dose of the medication in the six months before the boost.

The upshot was that 29.7% of the folks hadn’t been taking their earlier, lower dose regularly. (The study defined “adequate adherence” as filling a prescription often enough to have the pills on hand at least 80% of the time.) Around 7.4% of the patients studied had their earlier dose on hand less than half the time.

David Muzina, national practice leader for neuroscience at Medco, suggests that patients may be suffering from side effects or feel some stigma from being on an antidepressant. They may also simply not see any difference in symptoms if they skip a few doses. Still, he tells the Health Blog, as a psychiatrist he was “flabbergasted” by the number who weren?t taking their meds regularly, since patients are “generally really eager for help and want help” with conditions like depression.

The study also found that 65 or older were generally much more likely to be taking their antidepressants regularly, while those who were 18 or younger were much less reliable. Men were a bit better about taking their drugs than women. And people with more other medical conditions were also more compliant pill-takers. The study tied medication adherence to use of mail-order pharmacy, which PBMs like Medco tend to push over retail pickups. PBMs typically make more money when enrollees use their mail order services.

PBMs are getting increasingly aggressive about research and services that push medication compliance, which isn?t a big surprise because they make money partly based on prescriptions being filled. Their corporate clients are interested in such efforts because research shows that only about half of people who are prescribed drugs for chronic conditions are still taking them regularly after a year, and those dropouts can generate much bigger medical claims down the line.

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