As medication affordability increasingly becomes a focal point for policy makers, out-of-pocket (OOP) spending is a growing point of pressure for vulnerable populations, including those with mental health disorders. Avalere examined the burden of OOP spending on non-low-income subsidy (non-LIS) Medicare Part D beneficiaries using mental health medications.

Avalere analyzed patient progression through each phase of the Part D benefit. Among non-LIS beneficiaries taking mental health drugs of any kind during a year, 20% reached the coverage gap and 5% reached the catastrophic phase by the end of the year. Approximately half of those beneficiaries reached the coverage gap by mid-year and stayed there for an average of 4 months.

Additionally, Avalere found that beneficiaries assumed financial liability for 46% of the cost of their mental health drugs and 23% of the cost of their non-mental health drugs. This translates to an average of $760 per beneficiary in annual total OOP spending for non-LIS beneficiaries using mental health medications.

Methodology

Avalere analyzed 2018 Part D prescription drug event data as well as Medi-Span’s Generic Product Identifier therapeutic classification system to identify the following drug classes within the mental health category: antidepressants, antipsychotics, anxiolytics, and mood stabilizers. Avalere limited the analysis sample not to exceed 20% of the overall Part D beneficiary population and examined OOP costs for non-LIS Part D users of mental health drugs enrolled in non-employer group waiver plans.

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