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

In the second portion of the interview, Contreras continues reflecting on the AMCP Nexus study comparing dextromethorphan-bupropion (DM-BUP; Auvelity) with cariprazine, brexpiprazole, and esketamine for major depressive disorder. The findings—showing lower health care costs and reduced emergency department and inpatient utilization among patients starting DM-BUP—raise important questions about how managed care can support earlier adoption of treatments that may prevent costly care episodes for members who often cycle through multiple therapies.

Contreras explains that earlier identification of high-risk members is essential. Predictive analytics, risk stratification, and proactive outreach from behavioral-health care teams can help ensure timely initiation of the most appropriate therapies. He notes that reducing access barriers—such as streamlining prior authorizations, creating prescriber-specific fast-track pathways for behavioral health clinicians, and placing DM-BUP on more favorable formulary tiers—can further support early, appropriate use.

When discussing what evidence would strengthen payer confidence in moving DM-BUP earlier in the treatment sequence, Contreras highlights the need for additional real-world and head-to-head comparative data versus selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and atypical antipsychotics. He emphasizes the importance of functional outcomes like return-to-work rates, quality of life, relapse and remission patterns, longer-term cost savings, and measures of adherence and persistence. These data, he notes, would help demonstrate not only clinical value but meaningful downstream reductions in total cost of care—key considerations for managed care decision-making.