The rise in prescription drug costs affects all sectors of the health care industry, including private insurers, public programs and patients.

Spending on prescription drugs continues to be an important health care concern, particularly in light of rising pharmaceutical costs, the aging population and increased use of costly specialty drugs.

Currently accounting for roughly 10% of total health care costs (according to the Centers for Medicare and Medicaid Services' Office of the Actuary), prescription drug costs are trending higher than all other categories of health care spending.

In fact, according to Mercer, in 2007 the cost of prescription drugs represented the single largest share of health cost increases to employers.

In addition, the Kaiser Family Foundation indicates that prescription drug spending is projected to exceed spending on hospital care and other professional services this year. With this in mind, it's no wonder that companies often cite escalating prescription drug costs as one of the most challenging issues in health services delivery today.

At the heart of this issue are antidepressant and psychotropic medications. Because of their skyrocketing popularity, these medications are now the most widely prescribed class of drugs in the United States.

As a recent study by Columbia University/New York State Psychiatric Institute points out, antidepressant use in the U.S. nearly doubled between 1996 and 2005, along with a concurrent rise in the use of other psychotropic medications. The increase, according to Dr. Mark Olfson, who co-authored the study, seemed to span virtually all demographic groups.

Says Olfson in a 2009 article published in U.S. News and World Report, "Over 10% of people over the age of six receive anti-depression medication. That strikes me as significant."

e_SClBAlthough part of the rise can be linked to the fact that mental health treatment is becoming more common and accepted, many also attribute at least part of the surge in the use of antidepressants to the rate at which they are being prescribed by doctors outside of the mental health field.

According to Medco, five in six users of psychotropic medications are under the care of a general practitioner. At issue is the fact that the majority of GPs are not adequately trained to practice behavioral health, many having no formal training beyond the material marketed with the medication.

Asking a GP to treat mental health concerns is like asking him or her to perform brain surgery or a heart transplant. A doctor may have some general knowledge in those fields, but lacks the specific training or expertise to perform the procedure.

With most medical problems, a GP will refer the patient to a specialist for treatment. However, when it comes to addressing mental health issues such as depression or anxiety, most GPs will attempt to treat the condition without the support of a specialist - which often leads to misdiagnosis and over- or under-treatment.

Ultimately, this problem drives up health care premiums and disability costs, and affects organizational productivity via increased absenteeism and "presenteeism."

Start by identifying an effective treatment

An EAP-based pharmacy intervention program can address many of the problems associated with prescribing antidepressants and other psychotic drugs in a general medical setting, in addition to having a positive impact on prescription drug costs.

These programs are designed to help patients identify the most effective treatment for their mental health issues, whether it's through talk therapy, supervised medication or both.

When a licensed EAP counselor acts as a liaison between the employee and prescribing clinician, he or she is able to guide effective referrals, monitor treatment compliance, advise on health plan coverage, and provide counseling to the employee - either in support of or in lieu of medication.

This collaborative model integrates the efforts of GPs, psychiatrists, behavioral health organizations and, when possible, pharmacy benefit managers.

An EAP-based pharmacy intervention program can:

* reduce pharmacy costs and increase productivity for members and client organizations

* work with a member and their physician to build a course of action that is most appropriate for the situation

* educate members who are prescribed a psychotropic drug in a general medical setting

* increase awareness and utilization of employee assistance programs

With research from the NYU School of Medicine and the National Institute of Mental Health indicating that counseling for anxiety and depression is more effective than medication in certain situations, the positive impact of a pharmacy intervention program becomes even more apparent.

According to an article recently published in the Journal of the American Medical Association, psychotherapy has been shown to produce more lasting improvements than antidepressants or placebos.

In one study, 60% of patients successfully treated with psychotherapy remained free of depression six years later; most patients treated with antidepressants relapse within a year or two. What's more, treatment with psychotherapy has been shown to be less expensive than treatment with medication.

In addition to combating the pharmaceutical costs associated with depression and anxiety, increasing awareness and utilization of EAPs helps employers take direct aim at the indirect costs of those issues, such as absenteeism and presenteeism.

As an article in the February 2010 issue of the Harvard Mental Health Letter reports, a survey of a nationally representative sample reported that about 6% of employees experience symptoms of depression in any given year. Workers with depression lost an average of 27 work days per year - nine of which were the result of days away from work, and another 18 days were from a reduction in their productivity.

Other research has found that employees with depression are more likely than others to lose their jobs and to change jobs frequently.

Mental illness is also estimated to be the top illness-causing disability in the United States. The Work Loss Data Institute reports that there has been a 300% increase in mental health related Social Security disability claims over the past decade.

Utilization of EAPs has been shown to keep these alarming statistics at bay. Research from the Department of Health and Human Services found that employers with EAPs average 21% lower absenteeism rates and 14% higher productivity rates.

Assessing co-morbidity

EAP-based pharmacy intervention programs also have a positive impact on individuals with co-morbid conditions. As patients turn to their GP for help for their medical illnesses, it is not unusual for individuals to rely on their GP to help them with their mental health issues too.

Patients who have chronic conditions such diabetes, asthma, immunological disorders, or cancer have to make changes in their lifestyle that can sometimes be devastating from a psychological standpoint.

For example, someone suffering from multiple sclerosis may not be able to perform many of the mundane day-to-day tasks that they used to take for granted. This "new" lifestyle can lead to the individual feeling depressed or anxious.

Unfortunately, most GPs aren't equipped to identify and/or treat these types of behavioral co-morbidities, and will prescribe antidepressant medication(s) as a sole means of treatment. While this may help to alleviate some of the patient's symptoms, the overall problem is still there: "How do I cope with this change?"

In most cases, the underlying problem is never addressed.

Several studies have shown that a person's mental health affects their physical health (and vice versa). For individuals with co-morbid conditions, the primary benefit of an EAP-based pharmacy intervention program is that the behavioral health-related condition is not being neglected as the physical ailment is being treated.

A look under the hood

In an EAP-based pharmacy intervention program, when assessing someone with a chronic health issue who is also receiving psychotropic medications, a thorough evaluation is necessary to evaluate the root causes of the member's depression and/or anxiety.

In the aforementioned example of the person suffering from MS, a pharmacy intervention program would assess the person and recognize the losses that he or she has experienced as a byproduct of their debilitating illness.

While psychotropic medications may be helpful to alleviate some of the symptoms, a treatment plan that includes psychotherapy to help cope with the lifestyle changes would probably have been prescribed too.

One case that highlights how this type of program can assist an individual with a co-morbid medical condition involved a member who had a kidney transplant.

The member was taking anti-rejection medication and was being monitored closely by his doctors to ensure the kidney was working properly. During this process, the member became depressed and anxious.

Much his anxiety resulted from the belief that something was "going to go wrong" with the new kidney. He was also having problems adjusting to some the restrictions being imposed on him by his doctors, specifically regarding his return to work. In addition, because of the stress he had been experiencing, the member was prone to getting sick.

He and his doctors were beginning to be concerned that his body was rejecting the new kidney. His GP, noticing his anxiety, prescribed an anti-anxiety medication. This prescription triggered an intervention from the EAP-based pharmacy intervention program.

Through the program, the member was given a comprehensive assessment completed by licensed mental health professional, who was able to examine this case from a different perspective.

The member told the EAP clinician about some the stress he was experiencing as a result of returning to work, and the difficulties he was having getting back into a new routine.

The member's persistent worry that something was "going to go wrong" with the new kidney made him cut back on activities that he enjoyed doing for fear that he was going to get sick again. As result, the member had no stress-reducing activities and he spent much of his free time worrying about his kidney failing again.

The member had also started to isolate himself and was not using his support system (his family and friends) to help him through this challenging time.

He was becoming more and more depressed and, in turn, the depression was having an impact on his health. In a way, the member was causing his own worst fears to come true.

Once the EAP clinician was able to get an understanding of the member's fears and concerns, a course was action was prescribed that involved the member meeting on a weekly basis with a mental health provider who specialized in working with transplant patients.

The therapist helped the member develop specific coping skills that not only dealt with his fears, but also with the stress of being back to work. The member was also told to reconnect with his support system and was given some activities that helped him reduce his stress and anxiety.

The pharmacy intervention program coordinated the member's the mental health treatment with his medical treatment.

The mental health provider was able to work the member's doctor to ensure alleviate the member's concerns about what he could or could not do. During the course of the program, the member realized a reduction in his symptoms of anxiety and depression and he also began to feel better physically.

The member was able to develop a lifestyle that incorporated healthy outlets to alleviate his stresses. He was also able to adjust to the increased demand at work. Over time, the member became healthier, and he had no further problems with his kidney.

Because of the pharmacy intervention program, the member was able to make the necessary behavioral health-related improvements in his life. He avoided any further medical complications without needing to be placed on any psychotropic medications.

By working with his doctors, the EAP clinician demonstrated how the member's mental health was affecting his physical health and complicating his recovery.

Had this member continued with the initial course of action prescribed by his GP, the outcome would have been different, which would have lead to more medical complications such as rejection, kidney dialysis, loss work and continued long term disability.

Depression is a major public health concern, impacting quality of life for millions of individuals and placing an enormous economic burden on American businesses. In addition to the increased rates of absenteeism and workplace injuries and overall loss of productivity, the pharmaceutical costs associated with depression and related behavioral health issues are spiraling out of control.

As these drug costs continue to rise, employers need to find new and effective ways to manage them. A collaborative solution that integrates the expertise of GPs, psychiatrists, behavioral health organizations, PBMs and plan administrators is best equipped to tackle this problem head-on.

Anatomy of an EAP-based pharmacy intervention program

Step 1

A licensed clinician with specific training in psychopharmacology completes a comprehensive assessment of the member. This evaluation is used to obtain a psychosocial history and to determine whether the medication is being prescribed for a medical or a mental health condition.

Step 2

If the member has a mental health condition, the clinician will determine if the current course of action is clinically appropriate.

Step 3a

If the current course of action is appropriate for the member's condition, the clinician may recommend counseling through the EAP to support the medication.

Step 3B

If the current course of action is not appropriate for the member's condition, the clinician will recommend a new course of action. At this time, the clinician may contact the prescribing physician and discuss any recommended changes.

Step 4

The clinician will monitor the member's progress even after referrals have been made. To encourage the individual to access and comply with the appropriate mental health treatment, the counselor will follow up with the individual within a clinically appropriate timeframe.