Abstract
Antipsychotic medications play a central role in the treatment of schizophrenia and other psychotic disorders. In the last decade, second-generation antipsychotic agents have been introduced that are more expensive on a cost per daily dose basis than older agents. We review empirical data showing trends in prescribing patterns of first- and second-generation antipsychotic agents in the USA and the cost implications of these trends. We show how drug acquisition costs fit into the matrix of overall treatment costs, including pharmacy costs, in and out patient treatment and laboratory costs. We examine specific incentives that influence payers in these various domains and consider how incentives and policies might be constructed so that they serve to encourage effective treatment.