Wade Rolin L, Chen Chi-Chang, De Ajita P, Howard Jaren C
QuintilesIMS, Plymouth Meeting, PA.
Purdue Pharma L.P., Stamford, CT.
J Health Econ Outcomes Res. 2017 Jul 11;5(1):75-88. doi: 10.36469/9800. eCollection 2017.
Previous research demonstrated that utilization management (UM) such as prior authorization (PA) or non-formulary (NF) restrictions may reduce pharmacy costs when designed and applied appropriately to certain drug classes. However, such access barriers may also have unintended consequences. Few studies systemically analyzed the impact of major UM strategies to extended-release (ER) opioids on different types of health plans. This study evaluated, from payer perspective, the impact of formulary restrictions (PA, NF, or step therapy [ST]) for branded oxycodone HCl extended release (OER) on market share, and healthcare resource utilization/costs in ER opioids patients for multiple types of health plans in the United States. This retrospective, longitudinal case-control study analyzed prescription and outpatient medical claims data (2012 to 2015) for adult ER opioid patients from US plans (commercial,/Medicare, national/regional) that instituted OER PA, NF, or ST. Patients from each restricted plan (cases) were matched to patients in an unrestricted plan (controls) on key patient characteristics. ER opioid market share and healthcare resource utilization/costs for both cases and controls were evaluated for the 6-month period before and after the formulary restriction dates. A difference-in-differences (DiD) approach was utilized to evaluate change in the total per patient per month (PPPM) healthcare utilization and costs. The study comprised 1622 (national commercial PA), 2020 (regional commercial PA), 34 703 (national commercial ST), and 4372 (national Medicare NF) cases and equivalent number of controls. OER market share decreased after the formulary restrictions, with the national Medicare NF plan showing the greatest decrease (9.2%). DiD analyses indicated that PPPM office visit change in the PA and NF plans were non-significant (decreased by 0.1 and 0.2, P>0.05), but significant in the ST plan (increased by 0.1, P=0.0001). For most plans, no significant total monthly cost change was observed; PPPM costs decreased by $48.74 and $59.87 in ST and regional PA plans and increased by $37.90 in national NF plans (all P>0.05). This study observed that despite reducing the market share of OER, OER formulary restrictions had negligible impact on overall ER opioid utilization, and did not result in substantial pharmacy/medical cost savings.
先前的研究表明，诸如预先授权（PA）或非处方药（NF）限制等利用管理（UM）措施在针对某些药物类别进行适当设计和应用时，可能会降低药房成本。然而，这种获取障碍也可能产生意想不到的后果。很少有研究系统地分析主要的UM策略对缓释（ER）阿片类药物在不同类型健康计划中的影响。本研究从支付方的角度评估了品牌盐酸羟考酮缓释片（OER）的处方集限制（PA、NF或阶梯治疗[ST]）对市场份额以及美国多种类型健康计划中ER阿片类药物患者的医疗资源利用/成本的影响。这项回顾性纵向病例对照研究分析了来自实施OER PA、NF或ST的美国计划（商业/医疗保险、全国/地区）的成年ER阿片类药物患者的处方和门诊医疗索赔数据（2012年至2015年）。将每个受限计划（病例）中的患者与未受限计划（对照）中的患者在关键患者特征上进行匹配。在处方集限制日期之前和之后的6个月期间，评估病例组和对照组的ER阿片类药物市场份额以及医疗资源利用/成本。采用差异-in-差异（DiD）方法来评估每位患者每月（PPPM）医疗利用和成本的变化。该研究包括1622例（全国商业PA）、2020例（地区商业PA）、34703例（全国商业ST）和4372例（全国医疗保险NF）病例以及同等数量的对照。处方集限制后，OER市场份额下降，全国医疗保险NF计划下降幅度最大（9.2%）。DiD分析表明，PA和NF计划中PPPM门诊就诊变化不显著（分别下降0.1和0.2，P>0.05），但在ST计划中显著（增加0.1，P = 0.0001）。对于大多数计划，未观察到每月总成本有显著变化；ST和地区PA计划中PPPM成本分别下降了48.74美元和59.87美元，全国NF计划中增加了37.90美元（均P>0.05）。本研究观察到，尽管OER的处方集限制降低了其市场份额，但对总体ER阿片类药物利用的影响可忽略不计，并且并未带来实质性的药房/医疗成本节省。
