Marketplace Antidepressant Coverage and Transparency

Study notes that antidepressants are the most common category of drugs used by adults 18-44 and that 17 percent of Americans are likely to have a major depressive disorder at some point during their lifetime.

The Issue

Between 2005 and 2008, 11 percent of Americans age 12 and over were taking antidepressants, making antidepressants the third most commonly used prescription drug class. For many individuals, it may take trying several different antidepressants before finding one that works, making the case that there should not be limited access for patients. In this brief, researchers analyzed antidepressant coverage, cost-sharing requirements, and transparency in five states: Alabama, California, Florida, Maryland and Minnesota which were selected for their location, benchmark plan generosity, and mix of state-based and federally facilitated marketplaces.

Key Findings

The authors find a significant level of variability in marketplace antidepressant coverage:

  • 74 percent of insurers studied exclude anywhere from one to five antidepressants from their formularies (i.e., the list of drugs covered by a health plan);

  • And, some insurers exclude as many as 15.

Conclusion

Although progress has been made to make sure consumers can get the drugs they need, the authors recommend that marketplaces link directly to and display plan formularies, the expectations process be strengthened, require costs to be communicated in terms of co-pay, price tiers be standardized, prior authorization requirements be limited, and the types of tools for consumers be enhanced. 

About the Grantee

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulner­able, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff, and its recent research.