From Evidence to Equity: Leveraging Real-World HEOR Analysis to Transform Antidepressant Access Policy for Black Medicaid Beneficiaries in Maryland
Author(s)
Marie Wu, Master of Health Sciences.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Problem Statement: Johns Hopkins Medicine identified treatment disparities in major depressive disorder management among Black Medicaid beneficiaries in Baltimore, where restrictive prior authorization policies limited access to newer antidepressants with improved tolerability profiles. Maryland Medicaid medical directors and managed care organizations required evidence-based recommendations to inform formulary policy decisions affecting 45,000 predominantly Black beneficiaries while containing costs.
Description: Three major Medicaid managed care organizations and Maryland Medicaid leadership faced pressure to expand antidepressant access while demonstrating fiscal responsibility. JHM population health administrators needed data to support value-based contract negotiations and care pathway modifications. Community health advocates demanded evidence to support policy arguments addressing treatment disparities. Researchers conducted comprehensive real-world evidence analysis using electronic health records from 8,200 Black patients with major depressive disorder (2019-2022). Propensity score matching compared clinical and economic outcomes between newer-generation antidepressants versus standard generic options over 24-month follow-up. Multivariable regression models adjusted for demographics, comorbidities, and socioeconomic factors.
Lessons Learned: Newer antidepressants demonstrated superior medication adherence (68% vs 45%; OR 2.6, 95% CI 2.3-2.9), reduced emergency department utilization (31% decrease), and lower psychiatric hospitalization rates (18% decrease). Cost-effectiveness analysis yielded $15,200 per quality-adjusted life year gained with projected annual healthcare savings of $2,850 per patient. Policy implementation resulted in 340% increase in appropriate prescribing over 18 months, generating $1.2 million in avoided acute care costs system-wide. Real-world HEOR evidence proved essential for overcoming payer resistance by demonstrating clear return on investment. Success required sustained collaboration between academic medical centers, payers, and community advocates to translate rigorous economic evidence into actionable policy changes addressing treatment disparities. This case demonstrates how population-level HEOR analysis can drive meaningful healthcare policy reform while simultaneously improving outcomes and containing costs for vulnerable populations.
Stakeholder Perspective: Armed with this evidence, stakeholders successfully negotiated modified prior authorization criteria across all three managed care organizations, eliminating barriers for patients with documented treatment failures. Maryland Medicaid incorporated findings into statewide formulary policy updates, expanding access criteria specifically for populations with documented health disparities.
Description: Three major Medicaid managed care organizations and Maryland Medicaid leadership faced pressure to expand antidepressant access while demonstrating fiscal responsibility. JHM population health administrators needed data to support value-based contract negotiations and care pathway modifications. Community health advocates demanded evidence to support policy arguments addressing treatment disparities. Researchers conducted comprehensive real-world evidence analysis using electronic health records from 8,200 Black patients with major depressive disorder (2019-2022). Propensity score matching compared clinical and economic outcomes between newer-generation antidepressants versus standard generic options over 24-month follow-up. Multivariable regression models adjusted for demographics, comorbidities, and socioeconomic factors.
Lessons Learned: Newer antidepressants demonstrated superior medication adherence (68% vs 45%; OR 2.6, 95% CI 2.3-2.9), reduced emergency department utilization (31% decrease), and lower psychiatric hospitalization rates (18% decrease). Cost-effectiveness analysis yielded $15,200 per quality-adjusted life year gained with projected annual healthcare savings of $2,850 per patient. Policy implementation resulted in 340% increase in appropriate prescribing over 18 months, generating $1.2 million in avoided acute care costs system-wide. Real-world HEOR evidence proved essential for overcoming payer resistance by demonstrating clear return on investment. Success required sustained collaboration between academic medical centers, payers, and community advocates to translate rigorous economic evidence into actionable policy changes addressing treatment disparities. This case demonstrates how population-level HEOR analysis can drive meaningful healthcare policy reform while simultaneously improving outcomes and containing costs for vulnerable populations.
Stakeholder Perspective: Armed with this evidence, stakeholders successfully negotiated modified prior authorization criteria across all three managed care organizations, eliminating barriers for patients with documented treatment failures. Maryland Medicaid incorporated findings into statewide formulary policy updates, expanding access criteria specifically for populations with documented health disparities.
Code
IC6
Topic
Economic Evaluation
Disease
Mental Health (including addition)