Blue Review
A newsletter for physician, professional, facility, ancillary and Medicaid providers

October 2017

Antidepressant Medication Management Initiative

Blue Cross and Blue Shield of Texas (BCBSTX) is committed to improving the rate at which members remain on antidepressant medications after being newly diagnosed and treated for depression.

Did You Know?
According to the American Psychological Association (APA), Major Depressive Disorder is a chronic condition that requires patients to participate actively in and adhere to treatment plans for long periods, despite the fact that side effects or requirements of treatment may be burdensome.

APA guidelines recommend antidepressants as the initial treatment for mild to moderate depression.

Our Goal and Who Is Eligible?
Our goal is to increase antidepressant medication adherence. The initiative is targeting members age 18 and older with at least one of the following:

  • Principal diagnosis of major depression in an outpatient, emergency department intensive outpatient or partial hospitalization setting
  • At least two visits in an outpatient, emergency department, intensive outpatient or partial hospitalization setting on different dates of service with any diagnosis of major depression
  • At least one inpatient (acute or non-acute) claim

We measure adherence for both the acute and continuation phases as outlined in Healthcare Effectiveness Data and Information Set (HEDIS®) 2017 specifications:

  • Effective Acute Phase: Percentage of newly diagnosed and treated members who remained on an antidepressant medication for at least 84 days (12 weeks)
  • Effective Continuation Phase: Percentage of newly diagnosed and treated members who remained on an antidepressant for at least 180 days (6 months)

Comprehensive analysis of the results will be conducted quarterly and annually by BCBSTX.

What You Should Do

  • The physician should assess and acknowledge potential barriers to treatment adherence, including lack of motivation, side effects of treatment, and logistical, economic or cultural barriers to treatment. The physician should collaborate with the patient (and the family if possible) to minimize the impact of these potential barriers.
  • Patients should be given realistic expectations during the different phases of treatment. This includes the symptom-response time and the importance of medication adherence for successful treatment.
  • Misperceptions, fears and concerns about antidepressants should be addressed with the patient.
  • Education should be provided about major depression, the risk of relapse, the early recognition of recurrent symptoms, and the efficacy of Cognitive Behavioral Therapy in combination with medication.
  • Patients should be informed about the need to taper antidepressants rather than discontinuing them prematurely.
  • Common side effects of antidepressants should be discussed with the patient. The physician should encourage the patient to identify side effects they would consider reasonable and those they would consider unreasonable.
  • Physicians should explain when and how to take the medication, reminder systems, information about continuing the medication after symptoms of depression improve, strategies to incorporate medication into the daily routine and minimizing the cost of antidepressant regimens to improve adherence.

References
Practice Guideline for the Treatment of Patients with Major Depressive Disorder 3rd Edition, (2010) American Psychiatric Association

HEDIS 2017 Volume 2 Technical Specifications for Health Plans (the Healthcare Effectiveness Data and Information Set)

HEDIS is a registered trademark of NCQA.