Cost-Effective Strategies for Depression Management at AMCP Nexus

In this discussion, Steven Stoner, PharmD, a board-certified psychiatric pharmacist and associate dean for student affairs at the University of Missouri–Kansas City, School of Pharmacy, reviews data presented at AMCP Nexus and outlines how managed care organizations (MCOs) can support the use of cost-effective therapies for depression.¹ His analysis focuses on where the combination treatment dextromethorphan-bupropion (DM/BUP) may fit within the current treatment landscape.

Stoner emphasizes the importance of distinguishing between initial-onset unipolar depression and treatment-resistant depression (TRD), noting that higher-cost therapies such as cariprazine, brexpiprazole, and esketamine are typically reserved for TRD. To support earlier use of DM/BUP—and realize its potential for cost containment—MCOs need evidence that clearly demonstrates:

• Improved remission rates. Standard first-line antidepressants achieve remission in only about 30% of patients. For DM/BUP to be considered earlier in therapy, it must show stronger remission outcomes that help prevent the cycle of treatment failures leading to TRD
• Robust head-to-head data. Existing studies suggest DM/BUP is effective and may work rapidly, but MCOs require more comparative clinical trial data against traditional antidepressants before confidently positioning it as a first- or second-line option
• Strong adherence and safety. Long-term cost savings depend heavily on patient adherence. While twice-daily dosing may pose some risk, its safety profile and novel mechanism—targeting NMDA and sigma-1 receptors—may help avoid some concerns associated with traditional therapies.

Ultimately, Stoner notes that MCOs see the greatest cost benefits when an effective treatment prevents hospitalizations, reduces acute resource utilization, and supports individuals in returning to work and daily functioning. This focus on long-term functional improvement and reduced resource use strengthens the case for considering DM/BUP earlier in the treatment pathway.

Reference

1. Citrome L, Zhao Y, Zent C, et al. Real-world healthcare utilization 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.