OBJECTIVES: Insomnia is a risk factor for new and recurrent depression and is commonly treated with sedative hypnotics. Sedative hypnotics, however, are identified as high risk medications (HRM) because of their strong association with serious adverse drug reactions as evidenced by cognitive impairment and falls in the elderly. For this reason, the Scott & White Health Plan (SWHP) has identified sedatives as a targeted HRM class for its continuing quality improvement initiative, which includes the implementation of a pharmacist-led comprehensive medication review (CMR) program. The objective of this study is to evaluate the clinical outcome and cost impact of a CMR program targeting high-risk sedative hypnotics in elderly patients with depression compared with standard care.  METHODS: This was a retrospective analysis of medical and pharmacy claims from the SWHP of Medicare patients previously on at least one HRM claim two months pre-index. The index date was the first pharmacist contact in the CMR group and first physician office visit in the standard-care group from January 2013 to December 2014.  75 CMR patients were matched with 100 standard-care patients on age, gender, and previous HRM use. Office and outpatient visits for depression were assessed 1-year pre-index and 1-year post-index. RESULTS: A total of 175 Medicare patients were included in the data set. Patients in the CMR group had a 0.8% greater increase in depression-related office and outpatient hospital visits, but this difference was non-significant (p=0.98). However, healthcare increase in cost post-index date was significantly less in the CMR group compared to standard-care ($55,602 vs. $27666, p<0.05).  CONCLUSIONS: The results from the study demonstrate that a pharmacist-led CMR program targeting high-risk sedative hypnotics is associated with a reduction in healthcare costs in the elderly patients with depression.