Are claims trends for antidepressants sustainable?

Between 2000 and 2015, antidepressant drug consumption doubled in Organisation for Economic Co-operation and Development countries. This is potentially a reflection of people’s growing willingness to admit they need help, the availability of therapies and general attitudes around mental-health issues.

However, the consumption varies between countries, with Canada one of the top consumers.

Nancy Tibbo, senior manager of marketing and communications at Express Scripts Canada, says its data shows growth in the prevalence of depression, with 14.8 per cent of claimants using medication in 2018, up slightly from 14 per cent in 2017. “Our research also tells us that 26 per cent of claimants used a mental-health medication in 2018. This might be the more interesting and perhaps telling statistic.”

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According to Chris Goguen, manager of pharmacy benefit strategy at Medavie Blue Cross, the insurer’s claims data shows growth in overall spending on antidepressant medications has been flat since 2015, in large part due to generic drugs, which offer a reduced price compared to brand name drugs. “On the surface, not a red flag from a sustainable cost perspective,” he says. “But digging deeper into this use, the data uncovers trends worth further consideration.”

These trends include a 30 per cent increase in the number of antidepressant drug claimants. “This significant growth in plan members accessing treatment is an indicator of increased willingness to seek support, but also of the increasing mental-health challenges facing employees and employers today,” says Goguen.

There’s no question the rates of antidepressant prescriptions have climbed in developed countries, including Canada, says Peter Gove, innovation leader for health management at Green Shield Canada. “In the U.S., for example, rates of prescribing antidepressants increased by 400 per cent in 15 years. The U.K. and Australia have had similar increases in rates of prescribing.”

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The increases, he adds, began with the arrival of modern antidepressants such as Prozac in the late ‘80s. “The modern anti-stigma campaigns have likely resulted in many more people being willing to acknowledge their distress and ask for help.”

However, notes Gove, there’s also significant evidence these medications are being prescribed to people who have no formal diagnosis and may not benefit from them.

Generics pushing costs down

While Helen Stevenson, chief executive officer of Reformulary Group Inc., acknowledges the increase in both claims and claimants, she finds it interesting that the average cost per claim has decreased. “Overall, and certainly in our block, the total paid amount is decreasing. But that’s because the cost per claim is decreasing, likely because there are quite a lot of generic drugs that have come into this market and that’s providing some cost relief.”

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Antidepressant drug consumption in 2015

CountryDefined daily dose*, per 1,000 people
OECD average60.3

Source: OECD, 2017

* DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. DDDs are assigned to each active ingredient in a given therapeutic class by international expert consensus: for instance, the DDD for oral aspirin is three grams.

That said, the total spend on antidepressants is still high, says Stevenson, noting this speaks to the greater issue around mental health.

By and large, antidepressants are generic and reasonably inexpensive, says Gove. “High use pushes them to the top of most insurers’ lists in terms of total costs. We’ve seen a bit of a downturn in use with some of our big clients. It may be [that] we’ve reached the saturation point with these drugs, so costs might not increase as dramatically going forward.”

If a drug is effective and works in the long term, he notes, there can be savings for plan sponsors due to lower employee absence and disability. “And perhaps less long-term use of antidepressants will offset the cost and may provide an ROI.”

These challenges reinforce the need for new tools and integrated strategies for enhancing and accelerating member access and adherence to the most appropriate treatments and services, “in order to improve members’ outcomes and the cost-effectiveness of care,” says Goguen.

Alethea Spiridon is managing editor of Benefits Canada.