DESIGN, SETTING, AND PARTICIPANTS This analysis of the use of health services and spending for treatment of depression in the United States assessed data from the 1998 (n = 22 953), 2007 (n = 29 370), and 2015 (n = 33 893) Medical Expenditure Panel Surveys (MEPSs). Participants included respondent households to the nationally representative survey. Data were analyzed from June 15 through December 18, 2018. MAIN OUTCOMES AND MEASURES Rates of outpatient and pharmaceutical treatment of depression; counts of outpatient visits, psychotherapy visits, and prescriptions; and expenditures.

Prescription drug monitoring programs have a modest effect targeted at the high-profile drug oxycodone among the Medicare Part D population and an even smaller effect for hydrocodone and opioids in general. The findings suggest some substitution toward lower schedule opioids. Substantially addressing the widespread opioid abuse problem will require enhancing existing PDMPs or implementing new policies.

More than 40 000 people in the US died owing to opioids in 2016; the epidemic tops public health concerns. Opioids are commonly used for cancer-associated pain, and there has been a call for oncologists to become more aware of opioid-related risks and benefits. 1 It is unknown, however, if opioid-related deaths in cancer survivors are rising at the same rate as in the general population.Methods | Death certificate data were obtained from the National Center for Health Statistics (NCHS). Death certificates contain 1 underlying cause of death, up to 20 contributing causes, and demographic data. All deaths owing to opioids were included from 2006 through 2016; if present, cancer was noted as a contributing cause. Opioid-related death incidence was calculated from the US population and estimated cancer survivor population, 2 both via NCHS data. To assess for differences, χ 2 and R 2 tests were used. Statistical significance was defined as α < .05 on a 2-sided significance level. All statistical analyses were performed with SPSS, version 21 (IBM). The Duke University Medical Center Institutional Review Board provided a waiver (Pro00045337) for this study, given that it is publicly available deidentified data. Informed consent is waived for publicly available, deidentified databases. Data were collected from May through August 2018, and analysis was completed in September 2019.

No abstract

When the Medicare Part D prescription drug benefit was implemented in 2006, six drug classes were designated “protected classes.” Because responsibility for obtaining favorable drug prices depends on private insurers' abilities to negotiate with pharmaceutical manufacturers using the threat of formulary exclusion, the protected class designation could undermine the insurers' ability to control spending and utilization of drugs in these six classes. I estimate the effect of the protected class policy on U.S. national drug sales, utilization, and price using 2001–2010 IMS Health National Sales Perspectives data and Verispan Vector One: National data and controlling for drug and year fixed effects. I find that protected status beginning in 2006 led to $112–121 million per drug per year higher U.S. sales for drugs in protected classes relative to unprotected drugs. Greater sales were driven by the antidepressant, antipsychotic, anticonvulsant, and antineoplastic classes. Subsequent analyses on a subset of drugs reveal that increases in both price and quantity are responsible for the growth of sales in protected class drugs. These results are important for informing the recent and ongoing deliberation by the Medicare program over whether to remove several classes from protection.