Rise in Mental Health Prescriptions Does Not Equate to Rise in Costs According to a New Report by EmpiRx Health

Analysis finds that although drug utilization for mental health needs increased, drug spend was well controlled due to a value-based approach to pharmacy benefits

MONTVALE, NJ (October 6, 2022) – EmpiRx Health, the industry’s only value-based pharmacy benefit manager (PBM), released a new report today confirming its industry-differentiated healthcare model can manage payer costs and access to care against the stark impact the COVID-19 pandemic had on prescription drug use for mental and behavioral health. “Innovation in Pharmacy Benefits Report: Mental Health is Health” showcases how Americans increased their consumption of prescription drugs for depression, anxiety, and ADHD from 2020-2021 and proves it is possible for healthcare services to provide a system of support and sustain costs, especially in a time of crisis.

“The precept that mental health is health is laid bare by the pandemic and its continuing aftermath, as is the need for a concerted push toward value-based care,” said EmpiRx Health CEO Karthik Ganesh. “We published this data to shed light on this mental health tsunami as well as to demonstrate the successful outcomes of a financially aligned healthcare model. Healthcare service providers play a critical role in making appropriate care not only accessible, but affordable to all. Our data proves that with a value-based approach, we can ensure healthcare needs—whatever they may be—are met while still holding costs down.”

EmpiRx Health analyzed first-party data to identify trends emerging through drug utilization and plan spend year-over-year (YOY) from 2020-2021. The findings show that mental and behavioral health medication utilization increased, in line with industry trends, indicating that the demand for pharmacy care is being met. Uniquely, EmpiRx Health’s data reveals a major point of differentiation—decreased payer drug spend alongside increased drug utilization.

Key findings from EmpiRx Health’s analysis show:

  • Behavioral Health categories drove an increase of 9.4% in pharmacy claims year-over-year, 75% of these are anti-depressants.
  • Specific to anti-depressants, while year-over-year utilization increased by 12%, that demand was balanced with a decrease in gross spend per claim by 1.8%.
  • ADHD treatment data presented more interesting information. Adults 26+ have driven a consistent increase in ADHD treatment for 3+ years, now accounting for 50% of all ADHD utilizers.
  • Overall ADHD utilization increased by 20.2% year over year, countered by a striking 9.1% decrease in gross spend per claim.
  • From 2020-2021, across the book of business, EmpiRx Health saw a decrease of 4.7% in plan paid per utilizer.

Ganesh added, “Despite the rising drug utilization in the area of mental health, EmpiRx Health was uniquely positioned to provide our customers with the increased support they needed during the COVID-19 crisis while also managing costs. Our value-based PBM model is proof that it is possible to control spend and improve health outcomes. That’s healthcare done right.”

To read the “Innovation in Pharmacy Benefits Report: Mental Health is Health,” please click here.

About EmpiRx Health
EmpiRx Health is the industry’s most clinically advanced and only value-based PBM and has received multi-year recognition on the Inc. 5000 lists of America’s fastest-growing private companies. EmpiRx Health’s growth is fueled by the highly unique and client-aligned nature of its value proposition – a pay-for-performance financial model with guaranteed savings, an industry-first and client-tailored population health management approach, and an unparalleled high-touch service experience that has resulted in industry-best client retention rates.

Media Contact:
Heather Tidwell


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