Trends in behavioral treatment and mental health since the start of the pandemic
New research reveals that mental health has replaced COVID-19 as the top health issue among Americans, but more analysis needs to be done to find out if depression and anxiety are truly becoming more prevalent.
Over the past two and a half years, the COVID-19 pandemic has fundamentally changed the way we think about our health and the health of our people. As many Americans watch their finances closely, manage the stress of global politics, work from home and limit travel, mental health is an area of particular concern.
Mental health issues certainly existed before 2020, but the pandemic has heightened the need to address these common illnesses and the stigma surrounding them. New research finds mental health has replaced COVID-19 as the top health concern among Americans, but more analysis needs to be done to find out if depression and anxiety are truly becoming widespread, if people are more willing to discuss these once stigmatized conditions, or more researchers studying mental health more broadly.
One way to measure increases in the prevalence and treatment of mental health conditions is to look at long-term trends in prescribing data. Although large pharmacy benefit managers reported an increase in orders for drugs that help patients manage depression and anxiety early in the pandemic, many assume that these increases occurred because patients were reluctant to consult their doctor in person and stockpiled medications, often changing from 30 day supply to 90 day supply.
Some surveys have reported increased use of prescription drugs to support mental health. However, these surveys asked if individuals had taken medication in the past 4 weeks to help manage emotions, focus, behavior, or mental health, and are subject to measurement error based on response rates and the precision.
Aggregate, point-in-time data is often directionally useful, but lacks the specificity needed to understand deeper trends related to particular drug types or population-level behaviors. To dig deeper into trends in mental and behavioral health, Arrive Health looked at transaction volumes occurring in a commonly used real-time prescription benefit (RTPB) tool.
Prescription transaction data
Arrive Health offers RTPB services to more than 2,000 hospitals and health system sites, with more than 200,000 providers performing more than 7 million prescription transactions per month. A retrospective review of 12.44 million mental and behavioral health drug prescription transactions was conducted between February 1, 2020 and July 31, 2022.
Importantly, these services provide a connection between the electronic health record (EHR) workflow and pharmacy benefit management companies. Therefore, the data in this report represents drugs on hold in the e-prescribing workflow – when a physician enters a drug into their EHR order window – not necessarily the final drug sent to the pharmacy or confirmation. that the patient has recovered the drug.
As the size of the Arrive Health network changes as health systems, providers, and PBMs enable RTPB, the analysis and graphs below represent the percentage of our total prescription transaction volumes, which include drugs of the following classes:
- Anti-anxiety (benzodiazepines and more)
- Antidepressant (SSRI, SNRI, ATC, etc.)
- Antipsychotic (atypical and first-generation antipsychotics)
- Stimulating Therapies for Attention Deficit Hyperactivity Disorder (ADHD)
- Sedatives (hypnotics)
Key Transaction Results and Trends
The data shows that although prescribing volumes for behavioral and mental health drugs increased in early 2020 (likely for the above reasons), volumes only increased slightly in 2020 and appeared to have leveled off or slightly decreased over the next 2 years. At an all-time high, nearly 820,000 transactions for mental/behavioral health drugs occurred in May 2022, representing nearly 10% of total prescription transaction volume in the network and demonstrating the prevalence of the drug classes examined .
Arrive Health reported significant increases in certain drug deals in early 2020, including chloroquine, hydroxychloroquine, and albuterol. The increases ranged from 50% to nearly 125% and were likely caused by increasing publicity around these treatment options.
We followed up our initial message with data showing significant decreases in orders for these drugs. The changes in prescription volumes we see for mental/behavioral health drugs are much smaller in comparison.
Below, we highlight some of the interesting trends we discovered in our data:
- Between 2020 and mid-2022, backlog volumes for mental/behavioral health drugs remained between 9% and 10% of total transaction volume in our network.
- Since January 2022, we have seen a slight upward trend in mental/behavioral health transactions across our network.
- Anxiolytic drug transaction volumes have steadily declined from their peak of 2.34% in early 2021 to 1.97% in early 2022, but are on a slight upward trend in 2022.
- ADHD stimulant drugs have seen transactions increase significantly over the past 2.5 years, rising from a low of 1.1% in February 2020 to 2.05% in July 2022
- Reports support these data and indicate that ADHD rates are increasing in adults and have remained stable or increased in children.
- Some speculate that the increase in ADHD diagnoses is related to the influx of adults and students working/studying from home.
- Antidepressant treatment transactions saw slight increases in February 2021, October 2021 and June 2022. However, total volumes over the past 2.5 years have remained between 4.84% and 5.73%, indicating only slight increases. changes in total prescription volumes.
- JAMA recently looked at trends in benzodiazepine prescribing over the past 3 years and found some interesting results. In their report, they found a slight decrease in the volume of benzodiazepine prescriptions (with a peak in early 2020), which is consistent with the reduction in benzodiazepine transactions we have seen over time.
- Regular decreases like this could be due to many factors, which should be investigated further. Factors may include, but are not limited to, fewer patients being diagnosed with anxiety or insomnia, providers finding the medication less effective, or stigma surrounding a medication making its use less common.
- One area to continue to study is SSRI/SNRI volume, which fluctuated more in our data compared to JAMA research, which indicated small but steady increases in month-to-month prescription volumes.
Facilitate access to classes of essential drugs
Although Arrive Health’s data represents over 12 million prescription transactions, this information is not meant to be a scientific study or a definitive representation of mental or behavioral health issues in America. Instead, we hope to shed light on the broader trends we see in our data.
Unfortunately, there are still significant hurdles for patients to receive these types of essential medicines, including prior authorization and cost. Research shows that an increase of just $10 can reduce medication adherence by more than 10-20%. Additionally, the AMA has found that pre-authorization processes cause delays in care in 93% of cases.
Looking at the same 12.44 million transactions previously measured, we calculated that 34% of the time the provider had the option to select a lower cost drug option (totaling $114 million in potential patient savings). Additionally, 366,000 patients were seen for whom there was an opportunity to avoid a coverage restriction, including age restriction, out-of-network pharmacy, not on formulary, quantity limit and some form of medication.
where we go from here
It is essential that we continue to study mental health and its treatments. The industry also needs to do more to examine specific barriers to mental health care and understand trends in drug availability, cost and use.
For example, is reduced benzodiazepine transaction volume due to anxiety becoming less common? Or are doctors less confident in the drug’s effectiveness? Or are there cost barriers that prevent refills or cause dropouts?
Fortunately, efforts are underway to de-stigmatize mental and behavioral health and standardize its treatment nationwide. In particular, the government has focused on making mental health resources more widely available and requiring coverage for many mental health treatments.
Through a combination of policy change and technological innovation, industry can improve access to essential medicines by removing barriers to care and reducing costs for patients.
About the Author
Adam Rosenberg is a senior director at Arrive Health.