Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Clin Ther. 2011 Jan;33(1):135-44. doi: 10.1016/j.clinthera.2011.01.012.
Some Medicaid programs have adopted prior-authorization (PA) policies that require prescribers to request approval from Medicaid before prescribing drugs not included on a preferred drug list.
This study examined the association between PA policies for lipid-lowering agents in Michigan and Indiana and the use and cost of this drug class among dual enrollees in Medicare and Medicaid.
Michigan and Indiana claims data from the Centers for Medicare and Medicaid Services were assessed. Michigan Medicaid instituted a PA requirement for several lipid-lowering medications in March 2002; Indiana implemented a PA policy for drugs in this class in September 2002. Although the PA policies affected some statins, they predominantly targeted second-line treatments, including bile acid sequestrants, fibrates, and niacins. Individuals aged ≥18 years who were continuously dually enrolled in both Medicare and Medicaid from July 2000 through September 2003 were included in this longitudinal, population-based study, which included a 20-month observation period before the implementation of PA in Michigan and a 12-month follow-up period after the Indiana PA policy was initiated. Interrupted time series analysis was used to examine changes in prescription rates and pharmacy costs for lipid-lowering drugs before and after policy implementation.
A total of 38,684 dual enrollees in Michigan and 29,463 in Indiana were included. Slightly more than half of the cohort were female (Michigan, 53.3% [20,614/38,684]; Indiana, 56.3% [16,595/29,463]); nearly half were aged 45 to 64 years (Michigan, 43.7% [16,921/38,684]; Indiana, 45.2% [13,321/29,463]). Most subjects were white (Michigan, 77.4% [29,957/38,684]; Indiana: 84.9% [25,022/29,463]). The PA policy was associated with an immediate 58% reduction in prescriptions for nonpreferred medications in Michigan and a corresponding increase in prescriptions for preferred agents. However, the PA policy had no apparent effect in Indiana, where there had been little use of nonpreferred medications before the policy was implemented (3.3%). The policies were associated with an immediate reduction of $24,548 in prescription expenditures in Michigan and an immediate reduction of $16,070 in Indiana.
The PA policy was associated with substantially lower use of nonpreferred lipid-lowering drugs in Michigan, offset by increases in the use of preferred medications, but there was less change in Indiana. Data limitations did not permit the evaluation of the impact of policy-induced switching on clinical outcomes such as cholesterol levels. The monetary benefit of PA policies for lipid-lowering agents should be weighed against administrative costs and the burden on patients and health care providers.
一些医疗补助计划采用了事先授权（PA）政策，要求开处方者在开非首选药物清单上的药物之前向医疗补助计划申请批准。
本研究调查了密歇根州和印第安纳州降低血脂药物的 PA 政策与医疗保险和医疗补助双重参保者使用和成本之间的关系。
评估了医疗保健服务中心的密歇根州和印第安纳州的索赔数据。密歇根州医疗补助计划于 2002 年 3 月对几种降脂药物实施了 PA 要求；印第安纳州于 2002 年 9 月对该类药物实施了 PA 政策。尽管 PA 政策影响了一些他汀类药物，但主要针对二线治疗药物，包括胆汁酸螯合剂、贝特类药物和烟酸。本纵向、基于人群的研究纳入了 2000 年 7 月至 2003 年 9 月期间连续双重参加医疗保险和医疗补助的年龄≥18 岁的个体，包括在密歇根州实施 PA 之前的 20 个月观察期和印第安纳州 PA 政策实施后的 12 个月随访期。使用中断时间序列分析来检查 PA 政策实施前后降脂药物处方率和药房成本的变化。
共纳入密歇根州 38684 名和印第安纳州 29463 名双重参保者。队列中略多于一半为女性（密歇根州，53.3%[20，614/38684]；印第安纳州，56.3%[16，595/29463]）；近一半年龄在 45 至 64 岁之间（密歇根州，43.7%[16，921/38684]；印第安纳州，45.2%[13，321/29463]）。大多数受试者为白人（密歇根州，77.4%[29，957/38684]；印第安纳州：84.9%[25，25022/29463]）。PA 政策与密歇根州非首选药物处方的立即减少 58%相关，同时首选药物的处方相应增加。然而，印第安纳州的 PA 政策似乎没有效果，因为在该政策实施之前，非首选药物的使用量很少（3.3%）。这些政策与密歇根州处方支出立即减少 24548 美元和印第安纳州立即减少 16070 美元相关。
PA 政策与密歇根州非首选降脂药物的使用量大幅下降相关，同时首选药物的使用量增加，但在印第安纳州变化较小。数据限制使得无法评估政策诱导的药物转换对胆固醇水平等临床结果的影响。PA 政策对降脂药物的货币效益应权衡其对管理成本和患者及医疗保健提供者的负担。
