ProPublica is well known for creating interesting data bases that allow anyone hooked up to a computer to see by name whether a physician is accepting Big Pharma payments – from dinners to speaking engagements to consulting services. What may be lesser known is that occasionally ProPublica will publish other data that when carefully mined can reveal even more about the use of psychiatric drugs especially when there is a public funding source available.
This past week, we got more than a glimpse into the costs of psychiatric drugs by mining ProPublica’s listing of Medicare Part D prescriptions. Part D is the federal program that Social Security uses to pay pharmacies for all types of medications — psychiatric and non-psychiatric. Their tables list all drugs and their costs for the most recent year available, 2012. If one separates out the data, it looks like this:
Abilify $1,740 M (or $1.7 billion)
Clozapine $109 million
Risperdal $405 million
Thorazine $29 million
Seroquel $709 million
Seroquel XR $472 million
Zyprexa $247 million
Ziprasidone $215 million
TOTAL: $4.766 billion
Fluoxetine $76 million
Lexapro $214 million
Paroxetine $95 million
Sertraline $118 million
Trazodone $64 million
Venlafaxine $214 million
TOTAL: $781 million
GRAND TOTAL$5.547 billion
The first observation is a no-brainer. There’s a lot of money involved. And since the pharmaceuticals are not registered as 501c3 organizations, there is a lot of profit taking place here. And these figures do not even include the costs of mood stabilizers and anti-anxiety agents!
The second observation is that the elderly (who are the main recipients of Part D medication insurance) are especially sensitive to the effects of these medications. This is an issue that the American Association of Retired Persons (AARP) has been harping on for years and even the federal Center for Medicare and Medicaid Services (CMS) has been trying to reduce the use of antidepressants.
A third observation — there can be many more, of course — is that Abilify wins the prize for the single most costly psychiatric medication. This is despite the fact that there is a Black Box warning about the use of this particular drug that reads in part: “Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.”
Something is radically and systematically wrong here. The system issue is in part illustrated by the fact that most front-line staff in nursing homes would say they are overwhelmed with their work in caring for people with such debilitating problems as psychosis and depression. One way of silencing these concerns is simply to medicate them away. If my supposition is correct, there will need to be major overhauls of policy and funding and training in facilities serving our mothers and fathers and grandmothers and grandfathers. It would seem that taking savings from reducing the use of psychiatric drugs could go a long way towards increasing staff and training.
Finally, just to put some of the dollar figures into perspective, I would point out that in little Oregon, with my annual services budget of about $500 million (which included state hospitals, all mental health and addictions outpatient, residential, prevention, supported housing, acute inpatient and on and on down to prevention) we calculated after I left my commissioner position that the state was spending an additional $200 million in psychiatric drugs.
Here’s the point — this did not include Part D psychiatric drug costs. Calibrated down to Oregon, they would have added another $50 million–and this doesn’t include the cost of these drugs in Skilled Nursing Facilities (SNFs) that have the cost of drugs compensating through daily rates rather than separate billing to Medicare Part D. So the public costs of psychiatric drugs is approximately one half that of the entire services budget.
I will leave it to the readers of Mad in America and the Foundation for Excellence in Mental Health Care to draw their own conclusions. My personal belief is that it’s time to do even more advocacy and oversight and public policy work to deal with what looks like an obvious set of problems.
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Some pertinent MIA News posts:
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.