October 31, 2019
Ashley Chiara, PharmD, clinical pharmacy consultant, Clinical Pharmacy Services, University of Massachusetts Medical School, explains why it is important to open up access to mental health services, destigmatize the discussion about patients who have mental health disorders and need treatment, and make sure health care providers are allowing adequate access to newer therapies.
My name's Ashley Chiara, I'm a clinical consultant pharmacist with UMass Medical School's Division of Commonwealth Medicine. I work within the Department of Clinical Pharmacy Services, and I provide formulary review, management strategies, recommendations, which are primarily for psychiatric medications.
One of my major responsibilities of my role is to oversee one of our initiatives for pediatric members who are on concerning psychiatric medication regimens. Primarily overall, I review behavioral health meds for the adult and child population.
During yesterday's presentation [at AMCP Nexus 2019] with one of my colleagues Dr. Mike Angelini, we reviewed the current landscape and the past landscape of depressive disorders appropriate diagnosis, and currently what we have for appropriate treatments and alternatives for when treatment isn't sufficient for particular patients or those who are considered treatment resistant in their disease.
We went through a really thorough background of what we currently have in our tool box and some of the newer agents that have come to market within the past five or six years. Then took a really deep dive into two of the more novel agents that were approved this past year with really new mechanisms of action, really targeting treatment‑resistant patients as well as patients with post‑partum depression who really didn't have treatment options before, that were tailored to their needs.
Then after going through a background review, we looked at kind of the prevalence and economic burden of depression. I noted that more often than not in a managed care setting we're looking at orphan disease states, or specialty drugs that seem to cost a lot, but we're putting on the back burner.
Some of the more chronic disease states where we have low‑cost drug alternatives, but there's a high number of patients who are inadequately treated that have a lot of cost burden to their disease. After going through that a little bit, talking about the pipeline agents that we have coming out, there's quite a few targeting a few different mechanisms.
We have some novel antidepressants with new mechanisms, we have some combination therapies with combining older drugs with existing drugs for some additive effects that we really didn't use before, and then also looking at some existing therapies that are going for newer indications. Kind of just setting up the future of what we can expect, and what we had up until this point.
What I hope that everyone would have taken from the presentation would be that first off, we've really had a high number of drugs but a very limited scope of how they've been working in the past. Finding treatments that would work for patients, we're adequately treating some patients, but not everyone.
I think there's ways that we can expand upon that, so I think it's important for everyone to realize what's coming down the pipeline, what we may be able to expand in the future, and how this may impact how we manage mental health medications whereas it's a large pool of low‑cost medications, more moving toward probably some novel approaches that may be additive as opposed to replacing their current medications.
The second thing that I think, I hoped everyone would take from it, and I talked about at the end, is the overall push whether you're a healthcare provider or not, to open up access to mental health services, destigmatizing the discussion about patients who have mental health disorders that need treatment.
Also just making sure that as healthcare providers we're being judicious about what we are choosing for patients, but also to make sure that we're allowing appropriate access and adequate access to some of the newer therapies for those patients who really need it, just knowing the push to get patients the right care that they need.
Where I see healthcare going in the next 5, 10 years, and I think it was really evident at this meeting as a whole, is the move towards value‑based care and really outcomes‑based care. I know that's something not brand new, not a new concept, but I think everyone's working really hard to figure out how to get that to work.
It sounds like a great concept, but we really want to make sure that we're providing care that is adequate and has positive outcomes, in that as from a payor perspective with these newer‑cost drugs whether they be for depression or not, that we're actually paying for drugs that work. Make sure that patients get what they need because they have a stake in their care, too.
I think just from discussions here and discussion everywhere, I think that's where the industry as a whole is moving, and probably should move. It's just a matter of everyone figuring out how to get there.