Center for Medication Use, Policy, and Economics, University of Michigan, Ann Arbor, MI 48109-1065, USA.
J Dermatolog Treat. 2010 May;21(3):178-84. doi: 10.3109/09546630903268247.
The introduction of novel therapeutic options for psoriasis has raised managed care's interest in controlling costs associated with dermatological treatments. Prior authorization (PA) can be a successful way of managing costs. However, experience with topical treatments for acne suggests that PA may not be cost-effective. The role of managed care in dermatology and the potential impact of PA requirements for novel topical therapies for psoriasis are considered.
Using a model based on recent survey data, total annual cost estimates for a managed care organization to cover psoriasis treatment with a topical agent with or without PA requirements were calculated and compared. Costs for treatment and administrative costs associated with PA processes were included. The model assumed 68 000 insured patients required treatment (with an additional 1% to account for abuse/misuse), an average wholesale price of $100 per prescription (each prescription filled 4x/year), and a cost of $20 to process each PA request.
The total annual costs were $28 573 600 when PA was required and $27 472 000 when PA was not required. Thus, there was a total annual loss to the managed care organization of $1 101 600 associated with PA requirements.
Requiring PA for novel topical treatments for psoriasis, such as the new two-compound product containing calcipotriene and betamethasone dipropionate (Taclonex((R)); Warner Chilcott (US), Inc.; marketed as Daivobet((R))/Dovobet((R)) outside US by LEO Pharma), is not likely to be cost-effective for a managed care organization.
新型银屑病治疗选择的出现引起了医疗保健机构对控制皮肤科治疗相关成本的关注。预先授权（PA）是一种成功的成本管理方法。然而，痤疮局部治疗的经验表明，PA 可能并不具有成本效益。本文考虑了医疗保健机构在皮肤科的作用以及新型银屑病局部治疗药物的 PA 要求的潜在影响。
使用基于最近调查数据的模型，计算并比较了管理式医疗组织覆盖有或无 PA 要求的局部用药物治疗银屑病的总年度成本估计值。包括治疗成本和与 PA 流程相关的管理成本。该模型假设 68000 名参保患者需要治疗（再增加 1%以考虑滥用/误用），每处方平均批发价为 100 美元（每个处方每年开 4 次），并且处理每个 PA 请求的成本为 20 美元。
需要 PA 时的总年度成本为 28573600 美元，不需要 PA 时的总年度成本为 27472000 美元。因此，与 PA 要求相关的管理式医疗组织的年度总损失为 1101600 美元。
对于新型银屑病局部治疗药物（如含有卡泊三醇和倍他米松二丙酸酯的新型双组份产品，Taclonex((R)；Warner Chilcott（美国），Inc.；在美国以外由 LEO Pharma 以 Daivobet((R)/Dovobet((R)) 销售），要求 PA 可能不符合管理式医疗组织的成本效益。
