Medication Burden in Patients With Major Depressive Disorder Enrolled in Medicare Advantage Plans.

This study was funded by Sage Therapeutics, Inc. and Biogen Inc. Medical writing and editorial support were provided by Humana Healthcare Research, Inc. and funded by Sage Therapeutics, Inc., and Biogen Inc. This study examined medication burden and antidepressant treatment (ADT) patterns among Medicare Advantage Prescription Drug (MAPD) plan beneficiaries ≥65 years newly-treated with ADT between 01/01/2017 and 09/30/2021. Baseline and follow-up periods were 12 months each. Acute phase adherence was defined as receipt of any antidepressant for ≥ 84 days within 115 days from the index date, and for maintenance phase ≥ 180 days within 232 days from index date. A total of 96,315 patients (mean age: 74.4 years; female: 64.9%; White: 79%; urban: 65.1%) were identified. On average, patients received 10.5 unique all-cause medications at baseline. All-cause per patient per day (PPPD) baseline pill burden increased from 5.3 to 6.6 during follow-up. MDD-specific PPPD pill burden was 1.2. SSRIs were the most commonly prescribed ADTs (75.9%). Approximately 67.5% of patients received only one ADT during follow-up; 99.4% received monotherapy first-line. ADT combination therapy was higher among patients with comorbid anxiety disorders (8.9%) vs. those without (6.5%). Proportion of patients adherent to ADT was 70.6% during acute phase and 46.2% during maintenance phase. Rates of non-persistence with ADT over 6 and 12 months of follow-up were 52.1% and 63.5% of patients, respectively. Prior research demonstrated that adherence and persistence to ADT was generally low in real-world settings, potentially due to a variety of factors including modest treatment effectiveness for some and requirements for sustained treatment duration. The findings document increased pill burden among MAPD beneficiaries with MDD and may suggest an additional factor that contributes to ADT adherence and persistence rates.