In This Issue

Requiring initial use of a lower-cost antidepressant before approval of a more expensive one, i.e., “step therapy,” decreases the cost of antidepressant drugs initially but is accompanied by increased expenses for inpatient and emergency room treatment. Mark et al. (p. 1202) compared health care expenditures for antidepressant users employed by two large companies using step therapy and by two companies without it. Not only did step therapy result in higher total payments to providers soon after implementation of step therapy, the difference increased over the next 2 years. During the same period, the advantage in prescription drug spending decreased. Dr. John Greden points out in an editorial (p. 1148) that requirements such as step therapy result in lower adherence to prescribed treatments.