Patients initiating pharmacotherapy are generally not receiving guideline-recommended care for insomnia and anxiety
While benzodiazepine and hypnotic medications are generally not indicated as first-line treatments for insomnia and anxiety, an alarming number of patients are being treated with these medications as the first and only treatment.
Big Health recently engaged Milliman to conduct a study on treatment patterns for traditional Medicare beneficiaries with insomnia disorder and generalized anxiety disorder (GAD) in the United States to determine how closely they aligned with guideline-recommended care.
Get a peek inside
Key report findings
- FDA labeling guidance for benzodiazepines and hypnotic medications recommends against prescribing for more than 30 days, but 76% of those under 65 taking medications for GAD and between 76%-81% of those under 65 taking medications for insomnia received prescriptions on a long-term basis (over 30 days).*
- While the usage of benzodiazepine and other hypnotic medications declined between 2019 and 2020, researchers found no corresponding rise in the use of psychotherapy. There was, however, a corresponding rise in the use of off-label medications such as trazodone and gabapentin.
- When comparing treatment rates among beneficiaries under 65 with GAD across race/ethnicity, in 2020 30% of non-Hispanic black and 23% of other races had a diagnosis but did not receive treatment compared to only 17% of non-Hispanic white beneficiaries.
Implications for health plans
Findings from the study highlight three key areas of concern for health plans:
- Performance on HEDIS measures
- Performance on value-based contracts
- Compliance with health equity mandates
A guideline-recommended alternative
Multiple clinical guidelines recommended cognitive behavioral therapy (CBT) as first-line treatment for insomnia and anxiety, traditionally delivered through in-person therapy.3 However, today’s landscape of high demand for services and short supply of therapists makes it impossible to scale traditional care. Big Health harnesses the power of CBT in a unique digital experience that enables everyone who needs care to access it. Sleepio for insomnia disorder and Daylight for GAD are non-drug, first-line treatments that have been rigorously tested and proven to be safe and effective. They can be easily implemented, delivered on a virtually limitless scale, and used safely in conjunction with other treatments.
Curious if this is the right solution for your organization? Contact us below.
Sleepio and Daylight are available as an adjunct to usual medical care for insomnia disorder or generalized anxiety disorder, respectively, for adults ages 18 and older, without FDA review under their COVID-19 policy.
- Bazell et al. (2022). Treatment Patterns for Generalized Anxiety Disorder and Insomnia in Medicare Fee-for-Service. White paper.
- Espie et al. (2012). Sleep; Carl et al. (2020). Depression and anxiety
- ACP (2023): https://www.acponline.org/clinical-information/clinical-guidelines-recommendations
*Medicare beneficiaries under 65 are eligible for Medicare due to their disability or end stage renal disease status.
During the COVID-19 public health emergency, Sleepio and Daylight are being made available as treatments for insomnia disorder and generalized anxiety disorder (GAD), respectively, without a prescription. Sleepio and Daylight have not been cleared by the U.S. Food and Drug Administration (FDA) for the treatment of insomnia disorder and GAD, respectively.
1. Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125-133.2. Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., … & Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675-700.3. Wilson, S., Anderson, K., Baldwin, D., Dijk, D. J., Espie, A., Espie, C., … & Sharpley, A. (2019). British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update. Journal of Psychopharmacology, 33(8), 923-947.4. King’s Technology Evaluation Centre. (2017, November 9). Overview: Health app: SLEEPIO for adults with poor Sleep: Advice. NICE. https://www.nice.org.uk/advice/mib129.5. Espie, C. A., Kyle, S. D., Williams, C., Ong, J. C., Douglas, N. J., Hames, P., & Brown, J. S. (2012). A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep, 35(6), 769-781.6. Carl, J. R., Miller, C. B., Henry, A. L., Davis, M. L., Stott, R., Smits, J. A., … & Espie, C. A. (2020). Efficacy of digital cognitive behavioral therapy for moderate‐to‐severe symptoms of generalized anxiety disorder: A randomized controlled trial. Depression and Anxiety, 37(12), 1168-1178.
DOC-3046 Effective 11/2023
