Effects of a prior-authorization policy for celecoxib on medical service and prescription drug use in a managed care Medicaid population. Export

@article{Hartung_ClinTher_2004, abstract = {BACKGROUND: Prior authorization (PA) is a poorly studied but commonly employed policy used by health care payers to manage the rising costs of pharmacy benefits. OBJECTIVE: The aim of this study was to evaluate the intended and unintended effects of a PA policy for celecoxib on pharmacy and medical-service utilization in a Medicaid managed-care organization. METHODS: This was a retrospective, interrupted time-series analysis of 22 monthly health-related utilization rates from January 1, 1999, to October 31, 2000. All Medicaid claims for CareOregon (a managed-care organization) and a fee-for-service program were reviewed. A model was constructed to evaluate changes in utilization of therapeutically related drug classes (eg, conventional nonsteroidal anti-inflammatory drugs [NSAIDs], gastrointestinal agents), office and emergency-department encounters, and hospitalizations before and after the PA policy was implemented on November 16, 1999. A secondary analysis evaluated these changes among a sample of prior NSAID users. RESULTS: After the PA policy was implemented, use of celecoxib was immediately reduced from 1.07 to 0.53 days' supply per person-year (58.9\%; 95\% CI, 50.0\%-67.9\%). The monthly rate of increase was also reduced (P < 0.001). Utilization changes were not observed in other drug classes. Similar changes were observed in the secondary analysis. An 18\% (95\% CI, 2.2\%-33.9\%) nonsignificant increase in emergency-department visits was observed in the entire sample after the PA policy was implemented. However, a similar change was not observed in the secondary analysis of prior NSAID users. No other changes in medical service encounters were noted after the PA policy was activated. CONCLUSIONS: This observational study found that celecoxib use was substantially reduced after the implementation of a PA policy. No important changes in use of other drug classes were detected. The overall increase in emergency-department visits--although not observed among previous NSAID users--should be explored on the individual level.}, address = {Oregon State University College of Pharmacy, Portland, USA.}, author = {Hartung, D. M. and Touchette, D. R. and Ketchum, K. L. and Haxby, D. G. and Goldberg, B. W.}, citeulike-article-id = {1533470}, citeulike-linkout-0 = {http://dx.doi.org/10.1016/j.clinthera.2004.09.013}, citeulike-linkout-1 = {http://view.ncbi.nlm.nih.gov/pubmed/15531015}, citeulike-linkout-2 = {http://www.hubmed.org/display.cgi?uids=15531015}, doi = {10.1016/j.clinthera.2004.09.013}, issn = {0149-2918}, journal = {Clin Ther}, keywords = {mm, pa\_research}, month = {September}, number = {9}, pages = {1518--1532}, posted-at = {2007-08-03 16:00:20}, priority = {5}, title = {Effects of a prior-authorization policy for celecoxib on medical service and prescription drug use in a managed care Medicaid population.}, url = {http://dx.doi.org/10.1016/j.clinthera.2004.09.013}, volume = {26}, year = {2004} }

TY - JOUR ID - Hartung_ClinTher_2004 L3 - citeulike-article-id:1533470 N2 - BACKGROUND: Prior authorization (PA) is a poorly studied but commonly employed policy used by health care payers to manage the rising costs of pharmacy benefits. OBJECTIVE: The aim of this study was to evaluate the intended and unintended effects of a PA policy for celecoxib on pharmacy and medical-service utilization in a Medicaid managed-care organization. METHODS: This was a retrospective, interrupted time-series analysis of 22 monthly health-related utilization rates from January 1, 1999, to October 31, 2000. All Medicaid claims for CareOregon (a managed-care organization) and a fee-for-service program were reviewed. A model was constructed to evaluate changes in utilization of therapeutically related drug classes (eg, conventional nonsteroidal anti-inflammatory drugs [NSAIDs], gastrointestinal agents), office and emergency-department encounters, and hospitalizations before and after the PA policy was implemented on November 16, 1999. A secondary analysis evaluated these changes among a sample of prior NSAID users. RESULTS: After the PA policy was implemented, use of celecoxib was immediately reduced from 1.07 to 0.53 days' supply per person-year (58.9%; 95% CI, 50.0%-67.9%). The monthly rate of increase was also reduced (P < 0.001). Utilization changes were not observed in other drug classes. Similar changes were observed in the secondary analysis. An 18% (95% CI, 2.2%-33.9%) nonsignificant increase in emergency-department visits was observed in the entire sample after the PA policy was implemented. However, a similar change was not observed in the secondary analysis of prior NSAID users. No other changes in medical service encounters were noted after the PA policy was activated. CONCLUSIONS: This observational study found that celecoxib use was substantially reduced after the implementation of a PA policy. No important changes in use of other drug classes were detected. The overall increase in emergency-department visits--although not observed among previous NSAID users--should be explored on the individual level. IS - 9 JF - Clin Ther SN - 0149-2918 AD - Oregon State University College of Pharmacy, Portland, USA. EP - 1532 TI - Effects of a prior-authorization policy for celecoxib on medical service and prescription drug use in a managed care Medicaid population. VL - 26 SP - 1518 KW - mm KW - pa_research AU - Hartung, DM AU - Touchette, DR AU - Ketchum, KL AU - Haxby, DG AU - Goldberg, BW PY - 2004/09// UR - http://dx.doi.org/10.1016/j.clinthera.2004.09.013 ER -