Driving Adoption of Combination Therapies for Treatment-Resistant Depression

EP: 1.Lower Costs, Better Outcomes: Managed Care Strategies for DM-BUP Adoption

EP: 2.From Data to Decisions: Enabling Early Adoption of Cost-Saving Depression Therapies

EP: 3.Reducing Costs for Alzheimer Disease With Better Tolerated Therapies

EP: 4.Leveraging Digital Monitoring for Major Depressive Disorder

EP: 5.Ensuring Timely Access to Next-Line Migraine Therapies

EP: 6.Multidisciplinary Approaches to Optimize Migraine Management

EP: 7.Cost-Effective Strategies for Depression Management at AMCP Nexus

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EP: 8.Driving Adoption of Combination Therapies for Treatment-Resistant Depression

Steven Stoner, PharmD, a board certified psychiatric pharmacist and associate dean for student affairs at the University of Missouri–Kansas City, School of Pharmacy, commented on data presented at AMCP Nexus regarding how managed care organizations (MCOs) can better support the early adoption of dextromethorphan-bupropion (DM/BUP) to reduce the burden of high-cost care down the line.1 Stoner asserts that the primary challenge is tackling treatment-resistant depression (TRD), which is costly due to both medication ineffectiveness and poor patient adherence. To justify the earlier use of DM/BUP, the focus must shift to demonstrating sustained benefit, not just acute effectiveness, as depression often requires long-term treatment.

Stoner emphasized that for DM/BUP to influence cost containment, its efficacy must be proven equal to or better than existing therapies upon initial selection. Crucially, the product needs to achieve remission rates significantly higher than the typical 30% seen with current first-line antidepressants. This success rate is essential for building a case for earlier utilization, thereby preventing the cycle of treatment failures that leads to expensive TRD strategies. Effective treatment, Stoner defined, is measured by patients engaging in work, having fewer lost days, participating socially, and ultimately, staying out of the hospital.

To boost MCO confidence, Stoner called for more robust, long-term data, extending for 1 to 3 years, to prove both sustained efficacy and safety. This data would directly translate into a reduction in both direct and indirect health care costs. He referenced the lessons from a previous trial, which demonstrated that switching agents often fails to improve remission rates, underscoring the need for a therapy that can effectively close this existing "gap in care."

Stoner noted a key advantage of DM/BUP over traditional TRD treatments, such as the use of second-generation antipsychotics. While antipsychotics are effective for augmentation, they introduce significant risks like metabolic concerns and drug-induced movement disorders. If DM/BUP can demonstrate effectiveness earlier, it allows MCOs to avoid these complex, high-risk, and costly regimens. Therefore, strong long-term data on effectiveness and reduced recidivism rates will be the key drivers for MCO adoption.

Reference

1. Citrome L, Zhao Y, Zent C, et al. Real-world healthcare utlization and costs associated with using dextromethorphan-bupropion extended-release tablets versus branded comparators for the treatment of major depressive disorder. Presented at: AMCP Nexus; October 27-30, 2025; National Harbor, Maryland. Abstract.