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


    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.


    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].


    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.

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    1R01 HS018577/HS/AHRQ HHS/United States
    5R01AG032249/AG/NIA NIH HHS/United States
    K01 MH092338/MH/NIMH NIH HHS/United States
    K01HS018072/HS/AHRQ HHS/United States
    K01MH092338/MH/NIMH NIH HHS/United States
    P30 DK092924/DK/NIDDK NIH HHS/United States
    P30DK092924/DK/NIDDK NIH HHS/United States
    R01 AG032249/AG/NIA NIH HHS/United States
    R01 DK080726/DK/NIDDK NIH HHS/United States
    R01DK080726/DK/NIDDK NIH HHS/United States
    U24 CA171524/CA/NCI NIH HHS/United States
    U24CA171524/CA/NCI NIH HHS/United States
    U58DP002721/DP/NCCDPHP CDC HHS/United States
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