Skip to main content

The Centers for Disease Control and Prevention (CDC) has estimated that about 16% of adults take prescription medications for behavioral health conditions, making behavioral medications some of the most prescribed medications in the United States. Yet the management of these therapies presents numerous challenges.

The reasons behind those medication management challenges are multiple and complex.

In this article, we discuss:

Behavioral health prescribing challenges

Lack of visibility into the full medication list

About 60% of patients with behavioral health conditions in outpatient care settings take two or more behavioral medications. This number doesn’t include non-behavioral medications the patient may be on. Multiple medications present a challenge for behavioral health providers who may not have time to review in detail every medication the patient takes.

Patients may also see multiple providers, adding further complexity to the medication management process. As a result, patients may be on duplicate therapies, may receive conflicting recommendations from different providers, or may stop their medication on the advice of a different provider without notifying the original prescriber.

Lack of interoperability between healthcare systems

The lack of interoperability is a common challenge in medication management, but it’s especially crucial in behavioral health medication management.

For instance, in the case of opioid use, prescribers need:

  • Access to past and current pain treatments to be able to fully evaluate patients and recommend the best options.
  • The ability to quickly assess each patient's opioid-related risks.
  • The tools to effectively identify trends in patients’ outcomes over time.

Unfortunately, multiple barriers often limit system interoperability.

Many states don’t allow the incorporation of data from their prescription drug monitoring program (PDMP) in electronic health records (EHRs) and clinical decision support systems (CDS). Accessing all relevant data across different health systems is laborious and sometimes impossible. Even if data is available, the time required to understand a patient’s full medication history is often daunting for providers who are already overburdened.

When data is available, healthcare organizations need to be able to quickly draw insights from the data to impact health and cost outcomes. Instead of comprehensive analysis to highlight insights and create actionable care plans, however, many medication management tools don’t provide care teams with evidence-based next steps to optimize medication for each patient’s unique and evolving health needs.

Lack of visibility into hospitalization history

According to the CDC, in 2020 behavioral health visits accounted for over 6 million of emergency department visits. During those visits and subsequent hospitalizations, behavioral medications may be stopped, started, or dosed differently. Once these patients leave the hospital, their behavioral health care providers don’t always receive the full picture of what happened during their hospitalization. As a result, care teams may not be able to effectively monitor patients to adjust and manage their medications.

Furthermore, patients may not be able to provide insight into their medications as any changes that occur during a hospitalization can confuse them. Patients can end up taking the wrong medications, taking both old and new prescriptions together when not intended, or not successfully making the switch to newly prescribed medications. This can result in adverse medication incidents, unintended Emergency Department visits, or even inpatient readmissions.

Lack of visibility into potential medication-related problems

Behavioral providers may not be able to identify drug-drug interactions, including interactions between non-behavioral and behavioral medications.

Over a third of older adults take five medications or more on average, often including antidepressants, which put them at increased risk of drug interactions, especially when they’re seeing multiple specialists for their different conditions. When a patient takes drugs that negatively interact, the patient may experience costly and severe side effects. Catching these drug-drug interactions before they result in costly interventions can improve the patient’s quality of life and health while reducing total cost of care for healthcare organizations.

Lack of insight into the patient's home environment

Providers may not know if patients filled their prescriptions or if they were unable to due to high copays or undesirable side effects. Data has shown that almost 5% of Medicare beneficiaries didn’t fill their prescriptions, and the risk of missing refills was significantly higher for people with behavioral health conditions.

Patients may not be able to fill their prescriptions for the following reasons:

  • Food insecurity — patients who experience food insecurity may be less likely to purchase their prescription. In addition to cost-related non-adherence, patients who are food-insecure may also stop taking their medications because they experience more adverse effects when they don’t eat.
  • Housing insecurity and economic status - patients with financial difficulties may prioritize basic survival needs in these cases.
  • Transportation – patients without access to transportation may not be able to visit their pharmacy to pick up their medication and are less likely to follow their treatment plan.

Not knowing what happens after they prescribe a medication to a patient may lead providers to keep changing treatment or increasing doses when addressing social determinants of health would have the biggest impact.

Consequences of medication management gaps in behavioral health

Increased polypharmacy

The lack of comprehensive medication management (CMM) in behavioral health can lead to an increase in polypharmacy. A medication may not work due to a drug interaction or a suboptimal dose. If those underlying medication-related problems are not resolved, the provider may prescribe additional medications to help the patients reach their therapeutic goals.

As a result, a patient may experience unnecessary polypharmacy which can lead to avoidable increased costs.

A study published in the Archives of Gerontology and Geriatrics estimated that in older people with multiple comorbidities and polypharmacy, for patients with at least one potentially inappropriate medication (PIM) over 10% of medication costs were spent on PIMs. The most common PIMs included behavioral health medications (e.g. benzodiazepines, antipsychotics, antidepressants). People in this study spent an average of $392 to $759 per year on PIMs.

In one review published in Advanced Therapy regarding antipsychotic augmentation, the authors found that combining antipsychotic medications was associated with direct costs ranging from about $24,000 to $29,000 per year. In contrast, clozapine monotherapy was associated with an estimated cost reduction of $23,000 per year, related to lower use of behavioral health-related emergency health services.

Poor patient outcomes

In addition to avoidable and costly polypharmacy, gaps in behavioral health medication management can lead to poor patient outcomes, especially for older patients. Older adults taking inappropriate medications are more likely to experience adverse drug reactions, cognitive decline, and functional limitations. They are also more likely to experience falls, which cost U.S. public health and private payers up to $50 billion per year. Another study looked at the impact of antidepressant misprescribing in older adults and found that it was associated with an increased risk of mortality.

Staggering costs

Medication management gaps in behavioral health result in higher healthcare costs. A Milliman research report estimated that people with behavioral health conditions represented 27% of patients. This same group accounts for 57% of healthcare costs, with average healthcare costs 3.4 times higher than people without those conditions ($12,272 vs $3,552).

One study from the Journal of Clinical Psychiatry estimated the economic cost of schizophrenia to be about $155.7 billion including direct healthcare costs of $37.7 billion, direct non-healthcare costs of $9.3 billion, and indirect costs of $117.3 billion.

Another review in Pharmacoeconomics found that the combined direct costs, suicide-related costs, and workplace costs of depression increased from $236.6 billion to $326.2 billion between 2010 and 2018.

Opioid prescriptions were estimated to cost $7.4 billion in 2012—an increase from $2.3 billion in 1999—which translates into millions of dollars paid at the state level by health plans. This cost doesn’t take into account the indirect costs of opioid overprescribing, namely the opioid use disorder and possible opioid overdoses that can happen, which the CDC estimated cost about $1,021 billion in 2017.

Supporting behavioral health providers

An aging patient population, increasing chronic disease diagnoses, and the opioid epidemic require a different approach that supports behavioral health prescribers and optimizes medications for many patients with one outreach. Arine’s Prescriber Analytics solution enables health plans and risk-bearing providers to address drug-related problems at the prescriber level, identifying outlier prescribing patterns and empowering care teams to reach out to prescribers with actionable, evidence-based recommendations to inform decision-making.

A tool to build trust with providers

Traditionally, prescribers receive very general medication-related communications that do not provide context and evidence-based recommendations to support informed decision-making.

Arine’s Prescriber Analytics solution analyzes a host of patient-specific considerations to ensure that providers receive medication therapy change recommendations only for true prescribing issues.

By focusing prescriber outreach on relevant interventions, Arine’s medication intelligence platform reduces notification fatigue for prescribers and leads to higher prescriber engagement.

A solution that provides the right data context

Arine’s approach to prescriber outreach improves behavioral health medication management by providing the right data context to prescribers.

Arine’s platform provides evidence-based reasons for each recommended change, such as why patients may be non-adherent or potential medication-related problems that could result from drug-drug interactions.

By sharing the reasons behind the recommendations to their providers, healthcare organizations using Arine resolve an average of 50% of medication-related problems, compared to a 10% resolution rate or less achieved through typical academic detailing programs.

Prioritize the most impactable issues and patients

Traditional medication management systems often offer a limited ability for health plans to prioritize which patients and prescribers need outreach. Arine’s medication intelligence platform knows which medications, prescribers, and patients in a prescriber’s panel for whom intervention would lead to therapy optimization and cost-of-care savings. Focusing on high-risk patients and the most impactful interventions enables Arine to reduce total cost of care, impact larger numbers of patients with one outreach, and achieve each healthcare organization’s goals faster.

One health plan achieved between $1500 and $4300 per member per year in total cost savings using Arine’s Prescriber Analytics solution for their behavioral health member population.

Caring for patients holistically

Behavioral health providers often have limited time and resources to manage large numbers of complex patients. Arine’s Prescriber Analytics solution is a powerful tool that enables health plans to support providers and give them the insight they need to effectively manage their patients’ medications. It focuses on the most impactful interventions, helping health plans improve their patients’ health outcomes faster while significantly reducing costs.

Learn how one health plan achieved significant cost-of-care savings with Arine. Register for our webinar.

Blog Posts
Post by Sandy Bonfin, PharmD, BCPS
September 1, 2023
Sandy Bonfin, PharmD, BCPS, is a clinical pharmacist. She writes about medication optimization, medication intelligence, and health equity.