Economics of Formulary Design and Mental Health Policy
Principal Investigator: H A Huskamp
Abstract: [unreadable] DESCRIPTION (provided by applicant): Prescription drugs have become an increasingly important component of mental health treatment and the costs of psychotropic drugs have increased rapidly in recent years. However, there are major gaps in our knowledge about the economics of psychotropic drug treatment. This Mentored Research Scientist Development Award would allow Dr. Haiden Huskamp, a health economist with expertise in mental health policy and economic institutions, to supplement her economic tools with the knowledge and skills needed to conduct clinically-relevant and policy-significant research on the economics of prescription drugs used in the treatment of mental illnesses. The specific aims of this career development proposal are to: 1) develop a greater understanding of clinical decision-making related to the use of psychotropic drugs; 2) acquire basic knowledge of psychopharmacology; and 3) expand knowledge of the important economic institutions influencing the prescription drug market. In this undertaking, Dr. Huskamp will be guided by her sponsor, Richard Frank, PhD, and co-sponsors, Andrew Nierenberg, MD, and Ernst Berndt, PhD. Her career development plan includes guided study with Dr. Nierenberg on clinical issues related to treatment decision-making and Drs. Berndt and Frank on economic institutions of the pharmaceutical market, as well as coursework and participation in psychopharmacological "Grand Rounds," relevant seminar series, and professional meetings. Dr. Huskamp will use the knowledge and skills developed through these career development activities to conduct three research projects. The first project examines the effect of generic entry in the class of selective serotonin reuptake inhibitors (SSRls) on utilization patterns, costs, and market share among antidepressants as well as the competitive response of brand antidepressant manufacturers with respect to drug prices and promotional spending. The second project assesses the economic incentives created by three-tier drug formularies and how these arrangements affect costs, utilization patterns, and adherence to treatment guidelines in a non-elderly population. This project includes an economic welfare analysis of the tradeoffs associated with restrictive formularies. The third project examines the effect of a three-tier formulary on psychotropic drug costs and utilization patterns in a retiree population and explores the impact of formularies on the mental health costs of adding a prescription drug benefit to Medicare and on access to appropriate psychotropic drug treatment under such a benefit. The proposed plan of career development will provide Dr. Huskamp the training, mentoring, time and resources to develop the skills that will put her in a position to lead independent research on the economics of pharmaceutical treatment for mental illnesses.
Funding Period: 2002-07-15 - 2008-05-31
more information: NIH RePORT
- Medicare part D and the nursing home settingDavid G Stevenson
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
Gerontologist 48:432-41. 2008..The purpose of this article is to explore how the introduction of Medicare Part D is changing the operations of long-term-care pharmacies (LTCPs) and nursing homes, as well as implications of those changes for nursing home residents...
- Impact of 3-tier formularies on drug treatment of attention-deficit/hyperactivity disorder in childrenHaiden A Huskamp
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
Arch Gen Psychiatry 62:435-41. 2005..Many employers and health plans have adopted 3-tier formularies in an attempt to control costs for these and other drugs...
- Quality of care in a Medicaid population with bipolar I disorderAlisa B Busch
Alcohol and Drug Abuse Treatment Program, McLean Hospital, 115 Mill St, Belmont, MA 02478, USA
Psychiatr Serv 58:848-54. 2007..This study examined whether presenting diagnosis and treatment in intensive settings (hospitalization, partial hospitalization, or residential programs) are correlated with the subsequent treatment of bipolar I disorder...
- Medicare Part D and nursing home residentsDavid G Stevenson
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA
J Am Geriatr Soc 55:1115-25. 2007..Finally, it is unclear how well nursing homes and the pharmacies they work with will work across Part D plans, and vigilance will be required as the benefit proceeds...
- The effect of three-tier formulary adoption on medication continuation and spending among elderly retireesHaiden A Huskamp
Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115, USA
Health Serv Res 42:1926-42. 2007..To assess the effect of three-tier formulary adoption on medication continuation and spending among elderly members of retiree health plans...
- Rejections of drug claims for nursing home residents under Medicare Part DHaiden A Huskamp
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Health Aff (Millwood) 27:560-7. 2008..We examined data on claims in rejected status for one large long-term care pharmacy as of December 2006. There was considerable variation across PDPs in both rejection rates and reasons for rejection...
- Generic entry, reformulations and promotion of SSRIs in the USHaiden A Huskamp
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
Pharmacoeconomics 26:603-16. 2008..However, little is known about how newer strategies to extend patent life, including product reformulation introduction or obtaining approval to market for additional clinical indications, influence promotion...
- Case-mix adjustment of consumer reports about managed behavioral health care and health plansLaura L Eselius
Yale School of Public Health, 60 College Street, New Haven, CT 06520 8034, USA
Health Serv Res 43:2014-32. 2008..To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans...
- Part D and dually eligible patients with mental illness: medication access problems and use of intensive servicesHaiden A Huskamp
Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA
Psychiatr Serv 60:1169-74. 2009....
- Coverage and prior authorization of psychotropic drugs under Medicare Part DHaiden A Huskamp
Department of Health Care Policy, Harvard Medical School, and Division of General Internal Medicine, Brigham and Women s Hospital, Boston, MA 02115, USA
Psychiatr Serv 58:308-10. 2007..The effect of Part D will depend on the restrictiveness of the prior authorization and appeals processes, which is currently unknown...
- Impact of full mental health and substance abuse parity for children in the Federal Employees Health Benefits ProgramSusan T Azrin
Westat, 1650 Research Blvd, Rockville, MD 20850, USA
Pediatrics 119:e452-9. 2007..This study examined the effects of full mental health and substance abuse parity for children...
- The impact of parity on major depression treatment quality in the Federal Employees' Health Benefits Program after parity implementationAlisa B Busch
Department of Psychiatry, Harvard Medical School, McLean Hospital, Alcohol and Drug Abuse Treatment Program, Belmont, Massachusetts 02478, USA
Med Care 44:506-12. 2006..Major depressive disorder (MDD) is a prevalent but often undetected and undertreated and thus could potentially benefit from parity implementation...
- Does provider variation matter to health plans?Marisa Elena Domino
Department of Health Policy and Administration, The University of North Carolina at Chapel Hill, 1104G McGavran Greenberg Hall, CB 7411, Chapel Hill, NC 27599 7411, USA
J Health Econ 24:795-813. 2005..We test this model on data from a behavioral healthcare vendor that exercises some control over provider selection. We find little evidence that the plan responds to provider-level variance...
- The new medicare drug benefit: formularies and their potential effects on access to medicationsHaiden A Huskamp
Department of Health Care Policy, Harvard Medical School, Boston, Mass, USA
J Gen Intern Med 20:662-5. 2005..Such efforts should reduce administrative burden and better allow physicians to help patients obtain needed medications...
- Economic grand rounds: potential effects of the new medicare drug benefit on pricing for psychotropic medicationsHaiden A Huskamp
Harvard Medical School, 180 Longwood Ave, Boston, Massachusetts 02115, USA
Psychiatr Serv 56:1056-8. 2005
- Pharmaceutical cost management and access to psychotropic drugs: the U.S. contextHaiden A Huskamp
Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115, United States
Int J Law Psychiatry 28:484-95. 2005....
- Physical and mental health status of older long-term cancer survivorsNancy L Keating
Division of General Internal Medicine, Brigham and Women s Hospital, Boston, Massachusetts, USA
J Am Geriatr Soc 53:2145-52. 2005..To assess the physical and mental health status of older long-term cancer survivors...
- How the new medicare drug benefit could affect vulnerable populationsWalid F Gellad
Department of Medicine, Brigham and Women s Hospital, in Boston, MA, USA
Health Aff (Millwood) 25:248-55. 2006....
- Behavioral health insurance parity for federal employeesHoward H Goldman
University of Maryland School of Medicine, Baltimore, MD 21227, USA
N Engl J Med 354:1378-86. 2006..The plans were encouraged to manage care...
- Prices, profits, and innovation: examining criticisms of new psychotropic drugs' valueHaiden A Huskamp
Harvard Medical School, Boston, Massachusetts, USA
Health Aff (Millwood) 25:635-46. 2006....
- Longitudinal racial/ethnic disparities in antimanic medication use in bipolar-I disorderAlisa B Busch
Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts 02478, USA
Med Care 47:1217-28. 2009..To examine racial/ethnic longitudinal disparities in antimanic medication use among adults with bipolar-I disorder...