Effects of Eliminating Drug Caps on Racial Differences in Antidepressant Use among Dual Enrollees with Diabetes and Depression

Adams, Alyce S.; Soumerai, Stephen B.; Zhang, Fang; Gilden, Dan; Burns, Marguerite; Huskamp, Haiden; Trinacty, Connie; Alegria, Margarita; LeCates, Robert F.; Griggs, Jennifer; Ross-Degnan, Dennis; Madden, Jeanne M.

doi:10.1016/j.clinthera.2014.12.011

- Add this to...
- Twitter
- Facebook
- Google Bookmarks
- LinkedIn

Effects of Eliminating Drug Caps on Racial Differences in Antidepressant Use among Dual Enrollees with Diabetes and Depression

Published Date:

Jan 22 2015

Publisher's site:

http://dx.doi.org/10.1016/j.clinthera.2014.12.011 New Site Icon

Source:

Clin Ther. 37(3):597-609.

[PDF-835.12 KB]

Details:

Personal Authors:

Adams, Alyce S. ; Soumerai, Stephen B. ; Zhang, Fang ; Gilden, Dan ; Burns, Marguerite ; ... More ▼

Keywords:

[+]

Pubmed ID:

25620439

Pubmed Central ID:

PMC4390474

Description:

Purpose

Black patients with diabetes are at greater risk for underuse of antidepressants even when they have equal access to health insurance. This study aims to evaluate the impact of removing a significant financial barrier to prescription medications (drug caps) on existing black-white disparities in antidepressant treatment rates among patients with diabetes and comorbid depression.

Methods

We used an interrupted time series with comparison series (ITS) design and a 5% representative sample of all fee-for-service Medicare and Medicaid dual enrollees to evaluate the removal of drug caps on monthly antidepressant treatment rates. We evaluated the impact of drug cap removal on racial gaps in treatment by modeling the month-to-month white-black difference in use within age strata (<65, 65 or older). We compared adult dual enrollees with diabetes and comorbid depression living in states with strict drug caps (n=221) and without drug caps (n=1133) prior to the policy change.

Findings

The removal of drug caps in strict cap states was associated with a sudden increase in the proportion treated for depression (4 percentage points; 95% Confidence Interval: 0.03, 0.05, <0.0001) and in the intensity of antidepressant use (SMD: 0.05; 95% CI: 0.03, 0.07, p<0.001). While antidepressant treatment rates increased for both whites and blacks, the white-black treatment gap increased immediately after Part D [0.04 percentage points; 95% CI: 0.01, 0.08] and grew over time [0.04 percentage points per month (0.002, 0.01); P<0.001].

Implications

Policies that remove financial barriers to medicines may increase depression treatment rates among patients with diabetes overall while exacerbating treatment disparities. Tailored outreach may be needed to address non-financial barriers to mental health services use among African Americans with diabetes.

Document Type:

Journal Article

Collection(s):

CDC Public Access

Funding:

Supporting Files:

	nihms661329.nxml	application/octet-stream
	nihms661329f1.gif	image/gif
	nihms661329f1.jpg	image/jpeg
	nihms661329f2.gif	image/gif
	nihms661329f2.jpg	image/jpeg
	nihms661329f3.gif	image/gif
	nihms661329f3.jpg	image/jpeg

No Related Documents.

You May Also Like:

Effects of Transitioning to Medicare Part D on Access to Drugs for Medical Conditions among Dual Enrollees with Cancer

Personal Author:

Adams, Alyce S.; Madden, Jeanne M.; Zhang, Fang; Lu, Christine Y.; Ross-Degnan, Dennis; Lee, Angelina; Soumerai, Stephen B.; Gilden, Dan; Chawla, Neetu; Griggs, Jennifer J.;

Published:

Jul 06 2017

Source:

Value Health. 20(10):1345-1354.

Description:

Objective : To evaluate the impact of transitioning from Medicaid to Medicare Part D drug coverage on use of non-cancer treatments among dual enrollees with cancer. : Methods : We leveraged a representative 5% national sample of all fee-for-service d...

File Type:

[PDF - 291.38 KB]
Changes in Use of Lipid Lowering Medications among Black and White Dual Enrollees with Diabetes Transitioning from Medicaid to Medicare Part D Drug Coverage

Personal Author:

Adams, Alyce S.; Madden, Jeanne M.; Zhang, Fang; Soumerai, Stephen B.; Gilden, Dan; Griggs, Jennifer; Trinacty, Connie Mah; Bishop, Christine; Ross-Degnan, Dennis;

Published:

Aug 2014

Source:

Med Care. 52(8):695-703.

Description:

Background : The use of lipid lowering agents is suboptimal among dual enrollees, particularly blacks. : Objectives : To determine whether the removal of restrictive drug caps under Medicare Part D reduced racial differences among dual enrollees with...

File Type:

[PDF - 562.53 KB]
Predictors of latent tuberculosis infection treatment completion in the US private sector: an analysis of administrative claims data

Personal Author:

Stockbridge, Erica L.; Miller, Thaddeus L.; Carlson, Erin K.; Ho, Christine;

Published:

May 29 2018

Source:

BMC Public Health. 18.

Description:

Background : Factors that affect latent tuberculosis infection (LTBI) treatment completion in the US have not been well studied beyond public health settings. This gap was highlighted by recent health insurance-related regulatory changes that are lik...

File Type:

[PDF - 898.76 KB]
Generic Initiation and Adherence to Antidepressant Therapy under Medicare Part D

Personal Author:

Bao, Yuhua; Ryan, Andrew M.; Shao, Huibo; Pincus, Harold Alan; Donohue, Julie M.;

Published:

Dec 2013

Source:

Am J Manag Care. 19(12):989-998.

Description:

Objectives : To assess the effect of initiating antidepressant therapy with a generic prescription on adherence to antidepressant therapy among Medicare patients. A second objective is to assess how the effect might be moderated by the Medicare Part ...

File Type:

[PDF - 898.62 KB]
Medical expenditures associated with major depressive disorder among privately insured working-age adults with diagnosed diabetes in the United States, 2008

Personal Author:

Shrestha, Sundar S.; Zhang, Ping; Li, Rui; Thompson, Theodore J.; Chapman, Daniel P.; Barker, Lawrence;

Published:

Mar 13 2013

Source:

Diabetes Res Clin Pract. 100(1):102-110.

Description:

Aim : We aimed at estimating excess medical expenditures associated with major depressive disorder (MDD) among working-age adults diagnosed with diabetes, disaggregated by treatment mode: insulin-treated diabetes (ITDM) or non-insulin-treated diabete...

File Type:

[PDF - 1.09 MB]