The Center for the Study of Rationality, The Hebrew University of Jerusalem, Jerusalem, Israel.
Br J Clin Pharmacol. 2011 Dec;72(6):997-1001. doi: 10.1111/j.1365-2125.2011.04044.x.
To evaluate whether rescinding the prior authorization (PA) requirement (managerial pre-approval) for losartan in an health maintenance organization (HMO) could reduce prescribing of the more expensive angiotensin receptor blockers (ARBs).
HMO physicians were notified that losartan would no longer require PA, and appropriate changes were made to the electronic prescribing computer program. The monthly distribution by drug of the number of prescriptions for ARBs dispensed for new patients was calculated before and after the policy change from data captured from electronic records. The proportion of patients (percentage and 95% confidence interval) treated with losartan who met the criteria for treatment with ARBs (hypertension or cardiac insufficiency in patients who have developed adverse effects in response to angiotensin-converting enzyme inhibitors or macroproteinuria) during the first month after the PA requirement was rescinded was calculated.
The total number of PA requests for ARBs declined by 48.6% from 961 in December 2008, the month before the policy change, to 494 the following January, rising again to 651 during January 2010. Prescription incidence changed from 121 to 255 patients treated per month (114% increase) for losartan, from 15 to 16 (6.7% increase) for candesartan, and from 89 to 71 (20.2% decrease) for valsartan. The duration of effect for decrease in ARB requests for the more expensive drugs was approximately 1 year. Only 23.3% (95% confidence interval 18.1-28.4) of patients receiving losartan met the criteria for receiving ARBs.
Rescinding the PA requirement for this drug alone was an effective limited-duration strategy for reduction of prescription of relatively expensive drugs.
评估在健康维护组织（HMO）中取消氯沙坦的事先授权（PA）要求（管理性预批准）是否可以减少更昂贵的血管紧张素受体阻滞剂（ARB）的处方。
通知 HMO 医生氯沙坦不再需要 PA，并且对电子处方计算机程序进行了适当的更改。从电子记录中捕获的数据，计算政策变更前后新患者开具的 ARB 处方数量的每月药物分布。取消 PA 要求后第一个月内，符合用 ARB 治疗标准（对血管紧张素转换酶抑制剂有不良反应或巨蛋白尿的高血压或心功能不全患者）的接受氯沙坦治疗的患者比例（百分比和 95%置信区间）。
ARB 的 PA 请求总数从政策变更前的 2008 年 12 月的 961 例下降了 48.6%，至次年 1 月的 494 例，然后在 2010 年 1 月再次上升至 651 例。氯沙坦的处方发生率从每月 121 例增至 255 例（增加 114%），坎地沙坦从每月 15 例增至 16 例（增加 6.7%），缬沙坦从每月 89 例降至 71 例（减少 20.2%）。对于更昂贵药物的 ARB 请求减少的效果持续时间约为 1 年。仅 23.3%（95%置信区间 18.1-28.4）的接受氯沙坦治疗的患者符合接受 ARB 的标准。
单独取消该药物的 PA 要求是减少相对昂贵药物处方的有效限时策略。
