A Publication of Northeast Physicians Hospital Organization  



Many of our quality measures for BCBS, HPHC and Medicare ACO focus on the diagnosis and treatment of MAJOR
DEPRESSION. Consider the following for these highly weighted measures: 
  1. DIAGNOSIS - According to Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-V) MAJOR DEPRESSION is characterized by > 1 episode with patient presenting with any of the following symptoms including:
    • emotional symptoms (i.e. diminished ability to experience pleasure, loss of interest in usual activities, sadness)
    • physical symptoms (i.e. fatigue, headache, sleep disturbance)
    • cognitive symptoms (i.e. inability to concentrate, confusion, indecisiveness)
    • psychomotor disturbances (i.e. slowed physical movements)1
    2. CODING - MAJOR DEPRESSION codes included in the quality measures are : 296.20 -296.25, 296.30 - 296.35, 298.0 and 311.
    • The code 311 (Depression NOS, not otherwise specified) should not be used IF depression is considered brief or situational.
    • Consider instead the following which do not trigger the MAJOR DEPRESSION measure:

a. 308.0 Acute reaction to major stress w/   

    depressive symptoms

b. 309.0 Brief depressive reaction

c. 309.0 - 309.2 - Depressive states associated 

    with stressful events

d. 309.4 Mixed adjustment reaction w/  

    depressive symptoms


3. TREATMENT-  When an antidepressant medication is prescribed AND a MAJOR DEPRESSION code is used, according to HEDIS, the patient should remain on the medication or an alternative for at least 6 months without more than 51 days of interruption (e.g. for  med changes, wash-out etc.)  

  • Antidepressant medications have been shown to be effective in the treatment of major depressive disorder and should be provided to patients diagnosed with moderate to severe depressive disorder as well as to patients who prefer pharmacological therapy.2
  • In general, the effectiveness of antidepressant medications are equal at comparable doses among agents between or within classes of medications.
  • Initial selection of an agent is highly dependent upon anticipated side effects, safety and tolerability, patient preference, history of familial response, concurrent medical history, and cost.1, 2
  • Variability in response to different agents may be due to patient-specific factors. Where one agent may be optimal for one patient, it may result in treatment failure in another patient. There is no evidence suggesting one agent to be the preferred agent in the treatment of major depressive disorder.


1. Wells BG, Dipiro JT, Schwinghammer TL, Hamilton CW, editors. Pharmacotherapy Handbook, 6th ed. Depressive disorders. New York: McGraw-Hill; 2006. p. 706-724.

2. American Psychiatric Association. Highlights of changes from DSM-IV-TR to DSM-5. Accessed August 2014,available at http://www.dsm5.org

3. Karasu TB, Gelenberg A, Merriam A, Wang P. Practice guideline for the treatment of patients with major depressive disorder, second edition. American Psychiatric Association. Apr 2000;1-78. Available from:


                   vs. COMPLIANCE

New partnership agreements between patients and providers are reflected in the currently accepted term medication "adherence".  It is defined as the "active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behavior to produce a therapeutic result" (Delamater 2006; Meichenbaum and Turk 1987). The lack of adherence to prescribed therapies is termed "medication non-adherence."

The term medication "compliance" used for years by healthcare providers suggests a contract between providers and patients.  More specifically, it is the act or process of complying to a desire, demand, proposal, coercion or a disposition to yield to others. Inclusion of the patient in the determination and success of therapy, as defined by the term "adherence" indicates this action more accurately than "compliance".

Some implications of adherence and non-adherence: 
  • About 20% to 30% of all medication prescriptions are never filled.
  • Only about 50% of medications are taken as prescribed by the provider.
  • Rates of medication adherence drop after first 6 months of treatment.
  • Direct cost estimates of non-adherence in 2009 were estimated at $100 to $289 billion annually in the U.S.
NEPHO is committed to raising awareness, promoting discussion among patients, providers, clinicians and pharmacists about ways to improve medication adherence. This topic will be addressed in detail in future issues. Stay tuned!
Visit www.nepho.org for valuable information, including: calendars, health plan information, fee schedules and more.
February  2015
      Volume 5 :  Issue 1      
In This Issue

For years generic medications have been recommended to save money for patients. Some experts believe this strategy has saved the American health care system billions of dollars.  A perfect example was when the blockbuster drug Lipitor became available as a generic, numerous manufacturers jumped on the bandwagon and prices for atorvastatin, the generic, plummeted from about $250 per monthly prescription to about $30. This is because generic meds are cheaper to bring to market than brand-name drugs and they involve little research and development,  In addition, they are priced lower because generics typically face intense competition.


Why all of a sudden are generic drug prices doubling and tripling?  


Common drugs on the market for years such as digoxin, doxycyline, levothyroxine and numerous vaccines have seen big price increases recently. Here are some reasons why:

1. Manufacturing: Several companies that had made doxycyline over the years, no longer found it profitable to provide a low-cost med with a small profit margin. Hence, fewer suppliers and high demand lead to increased prices.

2. Drug Shortages:  Recent generic drug shortages seem to complicate treatment strategies for providers. When one drug becomes unavailable the supply of alternative generic drugs gets stressed and prices rise.

3. Just because: In the case of digoxin, there is no drug shortage and several manufacturers have tripled digoxin prices with no explanation according to the FDA.  There is no new patent or new formulation and digoxin is not hard to make. What changed? The financial rewards of selling an ancient, lifesaving drug and company strategies to reap the benefits.
Colcrys (colchicine) - First-Time Generic 
Prasco announced the launch of an authorized generic version of Takeda's Colcrys (colchicine) 0.6 mg tablets. Colcrys is indicated for the prophylaxis and treatment of acute gout flares and for the treatment of familial Mediterranean fever. West-Ward and Hikma Pharmaceuticals recently launched Mitigare (colchicine)0.6mg indicated for prophylaxis of gout flares in adults. Colcrys (and its generics) and Mitigare cannot be automatically substituted for each other.
Produced by Northeast PHO.  For more information contact: 
Carol Freedman, RPh, MAS Clinical Pharmacist NEPHO 
[email protected] 
Les Sebba M.D., Northeast PHO Medical Director 
[email protected]