Impact of the STAR*D trial from the perspective of the payer

The authors discuss implications for private and public insurers of the STAR*D trial (Sequenced Treatment Alternatives to Relieve Depression), which found evidence that for second- and third-line treatment, no second-generation antidepressant was superior to another in terms of effectiveness or of the overall incidence of harmful effects. These findings have permitted payers to construct formulary coverage rules with more confidence and have highlighted the benefits of policies that improve access to care (for example, encouraging primary care treatment of depression) or promote treatment adherence (for example, implementing pay-for-performance initiatives).