EmpiRx touts savings from value-based approach to behavioral health therapy management

EmpiRx Health saw a significant increase in pharmacy claims for behavioral health therapies but found managing these treatments in a value-based approach can mitigate the costs.

The pharmacy benefit manager saw claims for behavioral health treatments grow 9.4% between 2020 and 2021, according to a new report released Thursday. Utilization of antidepressant medications grew by 12% year over year, and use of treatments for attention-deficit/hyperactivity disorder (ADHD) increased by 20.2%. 

However, per claim spend for antidepressants declined by 1.8% between 2020 and 2021, and per claim spend for ADHD drugs decreased by 9.1%, the PBM said.

“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," EmpiRx CEO Karthik Ganesh said in a release. "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," Ganesh added.

As the costs related to behavioral health needs balloon, employers and other plan sponsors are putting an increasing focus on providing support to mitigate the challenges. EmpiRx Health said recent data suggest untreated behavioral health conditions account for $210.5 billion in annual loss related to absenteeism, reduced productivity and medical costs.

Employees with depression are absent an average of 31.4 days per year and have a 35% reduction in positivity, EmpiRx said.

However, thanks to its value-based model, the PBM was able to effectively manage costs related to behavioral health therapy, according to the report. Plans paid 4.7% less per utilizer thanks to a value-based approach, and medication adherence was 93.5%.

"Our value-based PBM model is proof that it is possible to control spend and improve health outcomes," Ganesh said. "That’s healthcare done right.”