Prior authorization policies for selective cyclooxygenase-2 inhibitors in Medicaid: a policy review. Export

@article{Fischer_MedCare_July_2006, abstract = {BACKGROUND: Many state Medicaid programs use prior authorization programs to limit spending on cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs (coxibs). However, the evidence base for the prior authorization criteria has not been examined previously. METHODS: We determined whether prior authorization was required for coxibs in state Medicaid programs and collected data on what precise criteria needed to be met for a coxib prescription to be authorized. Prior authorization criteria were compared to clinical evidence regarding which patients are most likely to benefit from coxibs. RESULTS: By mid-2004, 35 states had implemented prior authorization requirements for coxibs. Of 5 major clinical factors that identify patients likely to benefit from coxibs, 18 states (51\%) included all 5 factors and 9 states (26\%) included 2 or fewer. Most states (33/35; 94\%) required a previous trial of nonselective nonsteroidal anti-inflammatory drugs before a coxib would be authorized. Several prior authorization programs included factors that had no connection to the clinical evidence. CONCLUSIONS: State Medicaid prior authorization policies for coxibs are heterogeneous in terms both of the criteria required to obtain a coxib and of the relationship of those criteria to clinical evidence. Development of clinically rational prescription drug policies should be a goal for all health insurers and represents an important priority for Medicare's prescription drug benefit program.}, address = {Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA. mfischer@partners.org}, author = {Fischer, M. A. and Cheng, H. and Schneeweiss, S. and Avorn, J. and Solomon, D. H.}, citeulike-article-id = {1526842}, citeulike-linkout-0 = {http://dx.doi.org/10.1097/01.mlr.0000218775.04675.fd}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/16799360}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=16799360}, doi = {10.1097/01.mlr.0000218775.04675.fd}, issn = {0025-7079}, journal = {Med Care}, keywords = {mm, pa\_research}, month = {July}, number = {7}, pages = {658--663}, posted-at = {2007-08-01 11:09:43}, priority = {5}, title = {Prior authorization policies for selective cyclooxygenase-2 inhibitors in Medicaid: a policy review.}, url = {http://dx.doi.org/10.1097/01.mlr.0000218775.04675.fd}, volume = {44}, year = {2006} }

TY - JOUR ID - Fischer_MedCare_July_2006 L3 - citeulike-article-id:1526842 N2 - BACKGROUND: Many state Medicaid programs use prior authorization programs to limit spending on cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs (coxibs). However, the evidence base for the prior authorization criteria has not been examined previously. METHODS: We determined whether prior authorization was required for coxibs in state Medicaid programs and collected data on what precise criteria needed to be met for a coxib prescription to be authorized. Prior authorization criteria were compared to clinical evidence regarding which patients are most likely to benefit from coxibs. RESULTS: By mid-2004, 35 states had implemented prior authorization requirements for coxibs. Of 5 major clinical factors that identify patients likely to benefit from coxibs, 18 states (51%) included all 5 factors and 9 states (26%) included 2 or fewer. Most states (33/35; 94%) required a previous trial of nonselective nonsteroidal anti-inflammatory drugs before a coxib would be authorized. Several prior authorization programs included factors that had no connection to the clinical evidence. CONCLUSIONS: State Medicaid prior authorization policies for coxibs are heterogeneous in terms both of the criteria required to obtain a coxib and of the relationship of those criteria to clinical evidence. Development of clinically rational prescription drug policies should be a goal for all health insurers and represents an important priority for Medicare's prescription drug benefit program. IS - 7 JF - Med Care SN - 0025-7079 AD - Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA. mfischer@partners.org EP - 663 TI - Prior authorization policies for selective cyclooxygenase-2 inhibitors in Medicaid: a policy review. VL - 44 SP - 658 KW - mm KW - pa_research AU - Fischer, MA AU - Cheng, H AU - Schneeweiss, S AU - Avorn, J AU - Solomon, DH PY - 2006/07// UR - http://dx.doi.org/10.1097/01.mlr.0000218775.04675.fd ER -