Antidepressants hazardous to health care coverage
Published February 24. 2004 8:30AM
Original story at

When Amy M. left her steady job to become a freelance advertising copywriter, she had no idea the antidepressant she took to combat depression would have an unexpected side effect. She couldn't get health insurance.

"I was turned down by Blue Cross, Blue Shield and Kaiser," said the 35-year-old California resident, who has been taking the antidepressant Celexa for several years. "My rejection letters from the insurance companies stated the reason for the denial: antidepressants."

With nearly 19 million Americans under a diagnosis of depression, antidepressant use is skyrocketing in the United States. The newer antidepressants are the second most commonly prescribed class of drugs in the country, according IMS Health, a firm that tracks the pharmaceutical industry.

Most Americans with health insurance are covered through their employer and have little problem getting coverage for antidepressants, but almost 10 percent of those insured have individual policies because they are self-employed, unemployed or work for a company that doesn't offer insurance.

People with individual insurance are vulnerable to rejection or higher rates due to any number of pre-existing conditions because, unlike group plans, they must answer detailed questions about their medical history to qualify.

Those with pre-existing conditions such as serious heart problems or a history of cancer may not be surprised to be rejected, but millions of Americans taking antidepressants for a variety of reasons - from anxiety to a bout of minor depression following a divorce or even to smoking cessation - may be shocked to have that prescription come back to haunt them.

To insurers, the widespread dissemination of these drugs is part of the problem.

"Pharmaceutical costs are one of the most expensive costs in the system right now, especially long-term maintenance drugs," said Michael Chee, a spokesman for Blue Cross of California.

In addition, experts have questioned the safety and effectiveness of these drugs. In the same week the Food and Drug Administration held hearings this month to look into whether some antidepressants cause suicidal behavior in children and teenagers, a college student taking part in a clinical trial for a new antidepressant by Eli Lilly Co. took her life.

But many people find it difficult to function without the drugs. Due to a temporary lapse in her insurance, Amy - who does not want to use her real name for fear that her condition would jeopardize future contract jobs - said she stopped taking her antidepressant because of the cost. Celexa ranges from $70 to more than $80 for a month's supply from online pharmacy sites.

"The psychiatrist totally scolded me for going off medication," she said. "He said I was healthy with medication and not healthy without it." She eventually got Kaiser to accept her for $303 a month, an expense that, in part, required her to move to find cheaper rent.

The use of antidepressants in this country has nearly doubled since 1998, with more than $13 billion in sales in 2003, according to IMS Health, a pharmaceutical consulting company. Eli Lilly reports that its breakthrough drug Prozac, the first in a new class of antidepressants, has been consumed by more than 35 million people since it was introduced to the U.S. market in 1988 and ranks second behind Zoloft in the number of prescriptions written.

A 2002 study by Columbia University researchers found that the percentage of people with a diagnosis of depression who were treated with antidepressants in an outpatient setting increased from 37.3 percent in 1987 to 74.5 percent in 1997, based on data from national medical expenditure surveys.

Insurers are inconsistent in how they deal with the matter.

"I know there are a lot more people taking antidepressants, but I haven't seen much change in underwriting practices in 10 years," said Janet Trautwein, a director at the National Association of Health Underwriters. "(Insurance companies) still consider mental health care to be a risk and a little bit of an unknown."

Unlike group plans, which are subsidized by employers, individual coverage is paid for entirely by the insurance company and the consumer. If the insurers accept too many applicants who take expensive medications, they will have to raise rates for all policyholders to pay for it.

Insurance companies say they are not discriminating against people with mental illnesses. Rather, they are struggling to provide the most affordable coverage for the largest number of people.