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

In the first part of the interview, Zachary Contreras, director of pharmacy benefits at Sharp Health Plan, comments on new real-world findings presented at the recent AMCP Nexus meeting.¹ The study he discussed compared dextromethorphan-bupropion (DM-BUP; Auvelity) with several branded treatment alternatives—cariprazine, brexpiprazole, and esketamine—for adults with major depressive disorder (MDD). The analysis evaluated 6-month health care resource utilization (HCRU) and total costs, showing that patients initiating DM-BUP had significantly lower overall health care spending and were less likely to experience emergency department visits or inpatient admissions. These results were evaluated in the context of notable annual cost differences: $18,715 for DM-BUP vs $19,931 for cariprazine, $20,762 for brexpiprazole, and $41,954 for esketamine.

Against this backdrop, Contreras discusses how managed care organizations can help guide utilization toward treatments demonstrating real-world cost containment. He emphasizes that cost-effectiveness must be considered from both the patient and health-plan perspectives—spanning affordability, access, and total cost of care. Strategies such as lowering formulary tiers, removing or simplifying prior authorizations, aligning utilization management with clinical guidelines, pursuing value-based contracts, and strengthening behavioral health integration can reduce barriers, improve outcomes, and support broader adoption of therapies with demonstrated real-world value.