Healthcare Reform and Behavioral Health: Impact of Health Exchanges and Medicaid Expansion on Prescribing for Schizophrenia, Major Depression, and Bipolar Disorder | Physician & Payer Forum | US | 2014

The Affordable Care Act has expanded access to insurance coverage to millions and has reformed health insurance requirements to assure more-comprehensive coverage of behavioral health and prescription drugs. Government reports estimate that more than 8 million people have enrolled in a health plan offered on the health insurance exchange, including 5.8 million estimated to have made their first payments. In addition, as many as 8 million people have gained coverage through the expansion of Medicaid in 26 states and the District of Columbia, creating a new, lucrative sales channel for the pharmaceutical industry.

These changes significantly increase the total demand for behavioral health therapies, including schizophrenia, major depression, and bipolar disorder. The broad availability of effective generic medications in these categories has prompted exchange-based plans to use narrower formularies, significant utilization controls, and high cost-sharing to maximize use of generics. The mainstay class of SSRI and SNRI antidepressants is fully genericized, and patent expirations in recent years have also opened up a variety of generic choices within the high-priced class of atypical antipsychotics. Nevertheless, some branded drugs have preserved substantial shares of prescribing in commercial plans. Therapies available for schizophrenia, major depression, and bipolar disorder include Bristol-Myers Squibb/Otsuka’s Abilify (aripiprazole), AstraZeneca’s Seroquel (quetiapine), Eli Lilly’s Zyprexa (olanzapine), Dainippon Sumitomo Pharma/Sunovion Pharmaceuticals’ Latuda (lurasidone), Actavis’ (formerly Forest Laboratories) Viibryd (vilasodone), and Pfizer’s Pristiq (desvenlafaxine). New and emerging therapies expected to launch will have to compete with generic therapies including a generic version of Abilify expected to become available in 2015.