Gleason Patrick P, Williams Clint, Hrdy Sally, Hartwig Steven C, Lassen David
Medical and Pharmacy Integration Services, Prime Therapeutics, LLC, Eagan, Minnesota 55121, USA.
Pharmacotherapy. 2005 Jul;25(7):924-34. doi: 10.1592/phco.2005.25.7.924.
To evaluate the effects of a cyclooxygenase (COX)-2 inhibitor prior authorization (PA) program on direct medical and pharmacy costs.
Prospective, pre- and postimplementation cohort study with reference group.
Large corporation in the Midwest.
Of 26,375 continuously enrolled members, 737 used a COX-2 inhibitor in the 3 months before January 1, 2003, when the PA program was implemented.
The PA program limits coverage for a COX-2 inhibitor to members with a documented risk for a nonselective nonsteroidal antiinflammatory drug (NSAID)-induced gastrointestinal adverse event. All pharmacy and medical claims and costs were analyzed from the payer's perspective for a 15-month period. Separate pharmacy cost comparisons and medical cost comparisons were made between the 3-month quarter before PA program implementation and each follow-up quarter after PA program implementation. In the 3 months after PA program implementation, 620 (84.1%) of 737 members had no claims for a COX-2 inhibitor, and during this period their pharmacy and medical costs initially declined 40.0% (p < 0.001) and 18.7% (p < 0.001), respectively, and remained significantly lower. Among a subgroup of 156 members who tried to fill a COX-2 inhibitor prescription but were denied coverage, pharmacy and medical costs initially declined, 48.1% (p < 0.001) and 10.3% (p < 0.001), respectively, with pharmacy costs remaining significantly lower; however, overall medical expenditures increased, then returned to baseline. No change was noted in physician outpatient encounters, and two members had an emergency department visit for abdominal pain with no gastrointestinal ulcerations or bleeds during the 12-month follow-up.
Among members denied coverage for a COX-2 inhibitor after implementation of a PA program, pharmacy costs declined without a medical cost increase associated with gastrointestinal diagnoses.
评估环氧化酶（COX）-2抑制剂预先授权（PA）计划对直接医疗和药房成本的影响。
采用参考组的前瞻性实施前和实施后队列研究。
中西部的一家大公司。
在26375名持续参保成员中，737人在2003年1月1日PA计划实施前的3个月内使用了COX-2抑制剂。
PA计划将COX-2抑制剂的保险范围限制于有记录显示存在非选择性非甾体抗炎药（NSAID）引起的胃肠道不良事件风险的成员。从支付方的角度分析了15个月期间的所有药房和医疗索赔及成本。在PA计划实施前的3个月季度与PA计划实施后的每个随访季度之间分别进行了药房成本比较和医疗成本比较。在PA计划实施后的3个月内，737名成员中有620名（84.1%）没有COX-2抑制剂的索赔，在此期间，他们的药房和医疗成本最初分别下降了40.0%（p<0.001）和18.7%（p<0.001），并仍显著较低。在156名试图开具COX-2抑制剂处方但被拒绝承保的成员亚组中，药房和医疗成本最初分别下降了48.1%（p<0.001）和10.3%（p<0.001），药房成本仍显著较低；然而，总体医疗支出增加，然后恢复到基线水平。在12个月的随访期间，医生门诊就诊次数没有变化，两名成员因腹痛到急诊科就诊，未发现胃肠道溃疡或出血。
在PA计划实施后被拒绝承保COX-2抑制剂的成员中，药房成本下降，且未出现与胃肠道诊断相关的医疗成本增加。
