Balancing Cost of Behavioral Health Drugs with Need for Effective Treatment

By managing the use of behavioral health drugs, Clinical Pharmacy Services helps achieve steep spending reductions for this expensive medication class. We identify and address polypharmacy, as well as opportunities for dose consolidation. These initiatives help patients achieve a better quality of life — and reduce both medication costs and hospitalizations.

Helping a Medicaid client

This state Medicaid client recently requested that we design a program combining dose consolidation and quantity limitation protocols for the lower strengths of five frequently prescribed, brand-name behavioral health medications:

• Abilify (aripiprazole)
• Zyprexa (olanzapine)
• Effexor-XR (venlafaxine)
• Lexapro (escitalopram)
• Zoloft (sertraline)

We evaluated utilization and cost outcomes of the drugs, and the resulting intervention led to cost savings of more than $310,000 for our client in six months. With dose consolidation, patients who take lower-strength, once-daily products in multiple units each day are converted to an equivalent dose — but with a higher-strength tablet or capsule that is taken only one time each day. When we contacted physicians whose patients would likely benefit from the dose consolidation program, 51 percent agreed to change their patients’ regimens.

Our approach

Clinical Pharmacy Services recommends behavioral health drugs that produce the best results for the lowest cost. However, we recognize that changing a patient’s medication can also negatively impact symptom management or quality of life. Our team, which includes certified psychiatric pharmacists as well as additional pharmacists and physicians with practical experience with this population, understands these considerations and other difficulties facing patients and their families.

Our creative and nontraditional approach takes into account the complexity and the personal nature of mental illness. We realize that relevant clinical consensus guidelines do not always exist or apply.