Hartung Daniel M, Touchette Daniel R, Ketchum Kathy L, Haxby Dean G, Goldberg Bruce W
Oregon State University College of Pharmacy, Portland, USA.
Clin Ther. 2004 Sep;26(9):1518-32. doi: 10.1016/j.clinthera.2004.09.013.
Prior authorization (PA) is a poorly studied but commonly employed policy used by health care payers to manage the rising costs of pharmacy benefits.
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.
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.
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.
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.
预先授权（PA）是一项研究较少但医疗保健支付方常用的政策，用于控制药房福利成本的不断上升。
本研究旨在评估塞来昔布PA政策对医疗补助管理式医疗组织中药房和医疗服务利用的预期和非预期影响。
这是一项回顾性中断时间序列分析，分析了1999年1月1日至2000年10月31日期间22个月度健康相关利用率。对俄勒冈医疗补助计划（一个管理式医疗组织）和一个按服务收费计划的所有医疗补助申请进行了审查。构建了一个模型，以评估1999年11月16日实施PA政策前后治疗相关药物类别（如传统非甾体抗炎药[NSAIDs]、胃肠道药物）的使用、门诊和急诊科就诊以及住院情况的变化。二次分析评估了先前NSAIDs使用者样本中的这些变化。
实施PA政策后，塞来昔布的使用立即从每人每年1.07天供应量降至0.53天供应量（58.9%；95%CI，50.0%-67.9%）。月增长率也有所降低（P<0.001）。其他药物类别未观察到使用变化。二次分析中观察到类似变化。实施PA政策后，整个样本中急诊科就诊次数有18%（95%CI，2.2%-33.9%）的非显著增加。然而，在先前NSAIDs使用者的二次分析中未观察到类似变化。PA政策启动后，未发现医疗服务就诊的其他变化。
这项观察性研究发现，实施PA政策后塞来昔布的使用大幅减少。未检测到其他药物类别使用的重要变化。急诊科就诊次数的总体增加——尽管在先前的NSAIDs使用者中未观察到——应在个体层面进行探讨。
