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Posted: April 29, 2008

Higher Rx Costs May Lead to Untreated Depression in Elderly

New cost-sharing policies of government and private insurers may prevent some older adults diagnosed with depression from filling new antidepressant prescriptions, according to an analysis published in the April issue of the journal Psychiatric Services.
The study, funded by the US National Institute of Mental Health (NIMH), examined eight years of data from a British Columbia, Canada, program that evolved from comprehensive prescription coverage to cost-sharing in which seniors were responsible for a part of the costs of their prescriptions.
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Adults age 65 and older are prone suffering from major depression, but treating them with antidepressants can cause problems due to cost and potential interactions with other medications taken. As a result, many of those diagnosed with depression do not fill an antidepressant prescription.
Dr. Philip Wang, of NIMH’s Division of Services and Intervention Research, and colleagues analyzed the province’s prescription data from January 1997 to December 2005.
After previously providing comprehensive prescription coverage, in January 2002 the province implemented a $10-$25 (Canadian) co-pay with each prescription. Co-payments require the patient to pay a fixed amount for each prescription.
Then, in May 2003, the co-pay policy was replaced with an income-based deductible and a 25% coinsurance payment after the deductible was met. Co-insurance requires the patient to pay a portion of the medication price, a potential hardship for people with many prescriptions.
After meeting an out-of-pocket ceiling, full coverage kicked in. The transition is similar to what many US elderly experience when they move from private insurance programs to Medicare, which also requires deductibles and coinsurance payments.
The researchers found that while neither policy change resulted in people discontinuing existing antidepressant prescriptions, each coverage policy change was associated with a decrease in the start of antidepressant therapy, suggesting that newly diagnosed seniors may not be filling new prescriptions.
The added costs likely prevented some from starting new prescriptions, said Wang and colleagues. Also, the researchers speculate that the stigma associated with antidepressants may have curtailed use, especially among those on lower fixed incomes.
Wang and colleagues conclude that the consequences of decreases in antidepressant initiation are unclear and will require more research.
(Article courtesy of

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