The Experts below are selected from a list of 9810 Experts worldwide ranked by ideXlab platform
Alyce S Adams - One of the best experts on this subject based on the ideXlab platform.
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association between prior Authorization for psychiatric medications and use of health services among medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization policies are commonly used by Medicaid programs to control psychotropic drug expenditures. This study examined the association of a prior-Authorization Policy for atypical antipsychotic and anticonvulsant agents with medication discontinuation and use of health services among patients with bipolar disorder.
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association between prior Authorization for medications and health service use by medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Objective:This study examined the association between a Medicaid prior-Authorization Policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. Methods:A pre-post design with a historical comparison group was used to analyze Maine Medicaid and Medicare claims data. A total of 946 newly treated patients were identified during the eight-month Policy (July 2003–February 2004), and a comparison group of 1,014 was identified from the prePolicy period (July 2002–February 2003). Patients were stratified by number of visits to community mental health centers (CMHCs) before medication initiation (proxy for illness severity): CMHC attenders, at least two visits; nonattenders, fewer than two. Changes in rates of medication discontinuation and outpatient, emergency room, and hospital visits were estimated. Results:Compared with nonattenders, at baseline CMHC attenders had substantially higher rates of comorbid mental di...
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impact of two medicaid prior Authorization policies on antihypertensive use and costs among michigan and indiana residents dually enrolled in medicaid and medicare results of a longitudinal population based study
Clinical Therapeutics, 2010Co-Authors: Stephen B Soumerai, Robert F Lecates, Amy J Graves, Christine Y Lu, Alyce S Adams, Fang Zhang, Dennis RossdegnanAbstract:Abstract Background: In response to rising pharmaceutical costs, many state Medicaid programs have implemented policies requiring prior Authorization for high-cost medications, even for established users. However, little is known about the impact of these policies on the use of antihypertensive medicines in the United States. Objective: The aim of this longitudinal, population-based study was to assess comprehensive priorAuthorization programs for antihypertensives on drug use and costs in a vulnerable Medicaid population in Michigan and Indiana. Methods: A prior-Authorization Policy for antihypertensives was implemented in Michigan in March 2002 and in Indiana in September 2002; Indiana also implemented an antihypertensive stepwise-therapy requirement in July 2003. Our study cohort included individuals aged ≥18 years in Michigan and Indiana who were continuously enrolled in both Medicaid and Medicare from July 2000 through September 2003. Claims data were obtained from the Centers for Medicare and Medicaid Services. We included all antihypertensive medications, including diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, β-blockers, α-blockers, and angiotcnsin II receptor blockers. We used interrupted time-series analysis to study Policy-related changes in the total number and cost of antihypertensive prescriptions. Results: Overall, 38,684 enrollees in Michigan and 29,463 in Indiana met our inclusion criteria. Slightly more than half of our cohort in both states was female (53.29%in Michigan and 56.32%in Indiana). In Michigan, 20.23% of patients were aged ≥65 years; 77.44% were white, 20.11% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. In Indiana, 20.07% were aged ≥65 years; 84.93% were white, 13.64% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. The implementation of both policies was associated with large and immediate reductions in the use of nonpreferred medications: 83.33% reduction in the use of such drugs in Michigan (-84.30 prescriptions per 1000 enrollees per month; P P P P = 0.04) and 1.82% in Indiana ( P = 0.02). Implementation of the policies was also associated with reductions in pharmacy reimbursement of $616,572.43 in Michigan and $868,265.97 in Indiana in the first postPolicy year. Conclusions: Prior Authorization was associated with lower use of nonpreferred antihypertensive drugs that was largely offset by increases in the use of preferred drugs. The possible clinical consequences of Policyinduced drug switching for individual patients remain unknown because the present study did not include access to medical record data. Further research is needed to establish whether large-scale switches in medicines following the inception of prior-Authorization policies have any long-term health effects.
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unintended impacts of a medicaid prior Authorization Policy on access to medications for bipolar illness
Medical Care, 2010Co-Authors: Christine Y Lu, Stephen B Soumerai, Fang Zhang, Dennis Rossdegnan, Alyce S AdamsAbstract:Objectives:Prior Authorization policies (PA) are widely used to control psychotropic medication costs by state Medicaid programs and Medicare Part D plans. The objective of this study was to examine the impact of a Maine Medicaid PA Policy on initiation and switching of anticonvulsant and atypical a
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prior Authorization for antidepressants in medicaid effects among disabled dual enrollees
JAMA Internal Medicine, 2009Co-Authors: Alyce S Adams, Robert F Lecates, Amy J Graves, Daniel Gilden, Thomas J Mclaughlin, Connie Mah Trinacty, Christine Y Lu, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization is a popular, but understudied, strategy for reducing medication costs. We evaluated the impact of a controversial prior Authorization Policy in Michigan Medicaid on antidepressant use and health outcomes among dual Medicaid and Medicare enrollees with a Social Security Disability Insurance designation of permanent disability. Methods We linked Medicaid and Medicare (2000-2003) claims for dual enrollees in Michigan and a comparison state, Indiana. Using interrupted time-series and longitudinal data analysis, we estimated the impact of the Policy on antidepressant medication use, treatment initiation, disruptions in therapy, and adverse health events among continuously enrolled (Michigan, n = 28 798; Indiana, n = 21 769) and newly treated (Michigan, n = 3671; Indiana, n = 2400) patients. Results In Michigan, the proportion of patients starting nonpreferred agents declined from 53% prePolicy to 20% postPolicy. The prior Authorization Policy was associated with a small sustained decrease in therapy initiation overall (9 per 10 000 population; P = .007). We also observed a short-term increase in switching among established users of nonpreferred agents overall (risk ratio, 2.88; 95% confidence interval, 1.87-4.42) and among those with depression (2.04; 1.22-3.42). However, we found no evidence of increased disruptions in treatment or adverse events (ie, hospitalization, emergency department use) among newly treated patients. Conclusions Prior Authorization was associated with increased use of preferred agents with no evidence of disruptions in therapy or adverse health events among new users. However, unintended effects on treatment initiation and switching among patients already taking the drug were also observed, lending support to the state's previous decision to discontinue prior approval for antidepressants in 2003.
Stephen B Soumerai - One of the best experts on this subject based on the ideXlab platform.
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association between prior Authorization for psychiatric medications and use of health services among medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization policies are commonly used by Medicaid programs to control psychotropic drug expenditures. This study examined the association of a prior-Authorization Policy for atypical antipsychotic and anticonvulsant agents with medication discontinuation and use of health services among patients with bipolar disorder.
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association between prior Authorization for medications and health service use by medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Objective:This study examined the association between a Medicaid prior-Authorization Policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. Methods:A pre-post design with a historical comparison group was used to analyze Maine Medicaid and Medicare claims data. A total of 946 newly treated patients were identified during the eight-month Policy (July 2003–February 2004), and a comparison group of 1,014 was identified from the prePolicy period (July 2002–February 2003). Patients were stratified by number of visits to community mental health centers (CMHCs) before medication initiation (proxy for illness severity): CMHC attenders, at least two visits; nonattenders, fewer than two. Changes in rates of medication discontinuation and outpatient, emergency room, and hospital visits were estimated. Results:Compared with nonattenders, at baseline CMHC attenders had substantially higher rates of comorbid mental di...
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impact of two medicaid prior Authorization policies on antihypertensive use and costs among michigan and indiana residents dually enrolled in medicaid and medicare results of a longitudinal population based study
Clinical Therapeutics, 2010Co-Authors: Stephen B Soumerai, Robert F Lecates, Amy J Graves, Christine Y Lu, Alyce S Adams, Fang Zhang, Dennis RossdegnanAbstract:Abstract Background: In response to rising pharmaceutical costs, many state Medicaid programs have implemented policies requiring prior Authorization for high-cost medications, even for established users. However, little is known about the impact of these policies on the use of antihypertensive medicines in the United States. Objective: The aim of this longitudinal, population-based study was to assess comprehensive priorAuthorization programs for antihypertensives on drug use and costs in a vulnerable Medicaid population in Michigan and Indiana. Methods: A prior-Authorization Policy for antihypertensives was implemented in Michigan in March 2002 and in Indiana in September 2002; Indiana also implemented an antihypertensive stepwise-therapy requirement in July 2003. Our study cohort included individuals aged ≥18 years in Michigan and Indiana who were continuously enrolled in both Medicaid and Medicare from July 2000 through September 2003. Claims data were obtained from the Centers for Medicare and Medicaid Services. We included all antihypertensive medications, including diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, β-blockers, α-blockers, and angiotcnsin II receptor blockers. We used interrupted time-series analysis to study Policy-related changes in the total number and cost of antihypertensive prescriptions. Results: Overall, 38,684 enrollees in Michigan and 29,463 in Indiana met our inclusion criteria. Slightly more than half of our cohort in both states was female (53.29%in Michigan and 56.32%in Indiana). In Michigan, 20.23% of patients were aged ≥65 years; 77.44% were white, 20.11% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. In Indiana, 20.07% were aged ≥65 years; 84.93% were white, 13.64% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. The implementation of both policies was associated with large and immediate reductions in the use of nonpreferred medications: 83.33% reduction in the use of such drugs in Michigan (-84.30 prescriptions per 1000 enrollees per month; P P P P = 0.04) and 1.82% in Indiana ( P = 0.02). Implementation of the policies was also associated with reductions in pharmacy reimbursement of $616,572.43 in Michigan and $868,265.97 in Indiana in the first postPolicy year. Conclusions: Prior Authorization was associated with lower use of nonpreferred antihypertensive drugs that was largely offset by increases in the use of preferred drugs. The possible clinical consequences of Policyinduced drug switching for individual patients remain unknown because the present study did not include access to medical record data. Further research is needed to establish whether large-scale switches in medicines following the inception of prior-Authorization policies have any long-term health effects.
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unintended impacts of a medicaid prior Authorization Policy on access to medications for bipolar illness
Medical Care, 2010Co-Authors: Christine Y Lu, Stephen B Soumerai, Fang Zhang, Dennis Rossdegnan, Alyce S AdamsAbstract:Objectives:Prior Authorization policies (PA) are widely used to control psychotropic medication costs by state Medicaid programs and Medicare Part D plans. The objective of this study was to examine the impact of a Maine Medicaid PA Policy on initiation and switching of anticonvulsant and atypical a
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prior Authorization for antidepressants in medicaid effects among disabled dual enrollees
JAMA Internal Medicine, 2009Co-Authors: Alyce S Adams, Robert F Lecates, Amy J Graves, Daniel Gilden, Thomas J Mclaughlin, Connie Mah Trinacty, Christine Y Lu, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization is a popular, but understudied, strategy for reducing medication costs. We evaluated the impact of a controversial prior Authorization Policy in Michigan Medicaid on antidepressant use and health outcomes among dual Medicaid and Medicare enrollees with a Social Security Disability Insurance designation of permanent disability. Methods We linked Medicaid and Medicare (2000-2003) claims for dual enrollees in Michigan and a comparison state, Indiana. Using interrupted time-series and longitudinal data analysis, we estimated the impact of the Policy on antidepressant medication use, treatment initiation, disruptions in therapy, and adverse health events among continuously enrolled (Michigan, n = 28 798; Indiana, n = 21 769) and newly treated (Michigan, n = 3671; Indiana, n = 2400) patients. Results In Michigan, the proportion of patients starting nonpreferred agents declined from 53% prePolicy to 20% postPolicy. The prior Authorization Policy was associated with a small sustained decrease in therapy initiation overall (9 per 10 000 population; P = .007). We also observed a short-term increase in switching among established users of nonpreferred agents overall (risk ratio, 2.88; 95% confidence interval, 1.87-4.42) and among those with depression (2.04; 1.22-3.42). However, we found no evidence of increased disruptions in treatment or adverse events (ie, hospitalization, emergency department use) among newly treated patients. Conclusions Prior Authorization was associated with increased use of preferred agents with no evidence of disruptions in therapy or adverse health events among new users. However, unintended effects on treatment initiation and switching among patients already taking the drug were also observed, lending support to the state's previous decision to discontinue prior approval for antidepressants in 2003.
Christine Y Lu - One of the best experts on this subject based on the ideXlab platform.
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association between prior Authorization for medications and health service use by medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Objective:This study examined the association between a Medicaid prior-Authorization Policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. Methods:A pre-post design with a historical comparison group was used to analyze Maine Medicaid and Medicare claims data. A total of 946 newly treated patients were identified during the eight-month Policy (July 2003–February 2004), and a comparison group of 1,014 was identified from the prePolicy period (July 2002–February 2003). Patients were stratified by number of visits to community mental health centers (CMHCs) before medication initiation (proxy for illness severity): CMHC attenders, at least two visits; nonattenders, fewer than two. Changes in rates of medication discontinuation and outpatient, emergency room, and hospital visits were estimated. Results:Compared with nonattenders, at baseline CMHC attenders had substantially higher rates of comorbid mental di...
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association between prior Authorization for psychiatric medications and use of health services among medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization policies are commonly used by Medicaid programs to control psychotropic drug expenditures. This study examined the association of a prior-Authorization Policy for atypical antipsychotic and anticonvulsant agents with medication discontinuation and use of health services among patients with bipolar disorder.
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impact of two medicaid prior Authorization policies on antihypertensive use and costs among michigan and indiana residents dually enrolled in medicaid and medicare results of a longitudinal population based study
Clinical Therapeutics, 2010Co-Authors: Stephen B Soumerai, Robert F Lecates, Amy J Graves, Christine Y Lu, Alyce S Adams, Fang Zhang, Dennis RossdegnanAbstract:Abstract Background: In response to rising pharmaceutical costs, many state Medicaid programs have implemented policies requiring prior Authorization for high-cost medications, even for established users. However, little is known about the impact of these policies on the use of antihypertensive medicines in the United States. Objective: The aim of this longitudinal, population-based study was to assess comprehensive priorAuthorization programs for antihypertensives on drug use and costs in a vulnerable Medicaid population in Michigan and Indiana. Methods: A prior-Authorization Policy for antihypertensives was implemented in Michigan in March 2002 and in Indiana in September 2002; Indiana also implemented an antihypertensive stepwise-therapy requirement in July 2003. Our study cohort included individuals aged ≥18 years in Michigan and Indiana who were continuously enrolled in both Medicaid and Medicare from July 2000 through September 2003. Claims data were obtained from the Centers for Medicare and Medicaid Services. We included all antihypertensive medications, including diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, β-blockers, α-blockers, and angiotcnsin II receptor blockers. We used interrupted time-series analysis to study Policy-related changes in the total number and cost of antihypertensive prescriptions. Results: Overall, 38,684 enrollees in Michigan and 29,463 in Indiana met our inclusion criteria. Slightly more than half of our cohort in both states was female (53.29%in Michigan and 56.32%in Indiana). In Michigan, 20.23% of patients were aged ≥65 years; 77.44% were white, 20.11% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. In Indiana, 20.07% were aged ≥65 years; 84.93% were white, 13.64% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. The implementation of both policies was associated with large and immediate reductions in the use of nonpreferred medications: 83.33% reduction in the use of such drugs in Michigan (-84.30 prescriptions per 1000 enrollees per month; P P P P = 0.04) and 1.82% in Indiana ( P = 0.02). Implementation of the policies was also associated with reductions in pharmacy reimbursement of $616,572.43 in Michigan and $868,265.97 in Indiana in the first postPolicy year. Conclusions: Prior Authorization was associated with lower use of nonpreferred antihypertensive drugs that was largely offset by increases in the use of preferred drugs. The possible clinical consequences of Policyinduced drug switching for individual patients remain unknown because the present study did not include access to medical record data. Further research is needed to establish whether large-scale switches in medicines following the inception of prior-Authorization policies have any long-term health effects.
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unintended impacts of a medicaid prior Authorization Policy on access to medications for bipolar illness
Medical Care, 2010Co-Authors: Christine Y Lu, Stephen B Soumerai, Fang Zhang, Dennis Rossdegnan, Alyce S AdamsAbstract:Objectives:Prior Authorization policies (PA) are widely used to control psychotropic medication costs by state Medicaid programs and Medicare Part D plans. The objective of this study was to examine the impact of a Maine Medicaid PA Policy on initiation and switching of anticonvulsant and atypical a
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prior Authorization for antidepressants in medicaid effects among disabled dual enrollees
JAMA Internal Medicine, 2009Co-Authors: Alyce S Adams, Robert F Lecates, Amy J Graves, Daniel Gilden, Thomas J Mclaughlin, Connie Mah Trinacty, Christine Y Lu, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization is a popular, but understudied, strategy for reducing medication costs. We evaluated the impact of a controversial prior Authorization Policy in Michigan Medicaid on antidepressant use and health outcomes among dual Medicaid and Medicare enrollees with a Social Security Disability Insurance designation of permanent disability. Methods We linked Medicaid and Medicare (2000-2003) claims for dual enrollees in Michigan and a comparison state, Indiana. Using interrupted time-series and longitudinal data analysis, we estimated the impact of the Policy on antidepressant medication use, treatment initiation, disruptions in therapy, and adverse health events among continuously enrolled (Michigan, n = 28 798; Indiana, n = 21 769) and newly treated (Michigan, n = 3671; Indiana, n = 2400) patients. Results In Michigan, the proportion of patients starting nonpreferred agents declined from 53% prePolicy to 20% postPolicy. The prior Authorization Policy was associated with a small sustained decrease in therapy initiation overall (9 per 10 000 population; P = .007). We also observed a short-term increase in switching among established users of nonpreferred agents overall (risk ratio, 2.88; 95% confidence interval, 1.87-4.42) and among those with depression (2.04; 1.22-3.42). However, we found no evidence of increased disruptions in treatment or adverse events (ie, hospitalization, emergency department use) among newly treated patients. Conclusions Prior Authorization was associated with increased use of preferred agents with no evidence of disruptions in therapy or adverse health events among new users. However, unintended effects on treatment initiation and switching among patients already taking the drug were also observed, lending support to the state's previous decision to discontinue prior approval for antidepressants in 2003.
Fang Zhang - One of the best experts on this subject based on the ideXlab platform.
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association between prior Authorization for psychiatric medications and use of health services among medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization policies are commonly used by Medicaid programs to control psychotropic drug expenditures. This study examined the association of a prior-Authorization Policy for atypical antipsychotic and anticonvulsant agents with medication discontinuation and use of health services among patients with bipolar disorder.
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association between prior Authorization for medications and health service use by medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Objective:This study examined the association between a Medicaid prior-Authorization Policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. Methods:A pre-post design with a historical comparison group was used to analyze Maine Medicaid and Medicare claims data. A total of 946 newly treated patients were identified during the eight-month Policy (July 2003–February 2004), and a comparison group of 1,014 was identified from the prePolicy period (July 2002–February 2003). Patients were stratified by number of visits to community mental health centers (CMHCs) before medication initiation (proxy for illness severity): CMHC attenders, at least two visits; nonattenders, fewer than two. Changes in rates of medication discontinuation and outpatient, emergency room, and hospital visits were estimated. Results:Compared with nonattenders, at baseline CMHC attenders had substantially higher rates of comorbid mental di...
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impact of two medicaid prior Authorization policies on antihypertensive use and costs among michigan and indiana residents dually enrolled in medicaid and medicare results of a longitudinal population based study
Clinical Therapeutics, 2010Co-Authors: Stephen B Soumerai, Robert F Lecates, Amy J Graves, Christine Y Lu, Alyce S Adams, Fang Zhang, Dennis RossdegnanAbstract:Abstract Background: In response to rising pharmaceutical costs, many state Medicaid programs have implemented policies requiring prior Authorization for high-cost medications, even for established users. However, little is known about the impact of these policies on the use of antihypertensive medicines in the United States. Objective: The aim of this longitudinal, population-based study was to assess comprehensive priorAuthorization programs for antihypertensives on drug use and costs in a vulnerable Medicaid population in Michigan and Indiana. Methods: A prior-Authorization Policy for antihypertensives was implemented in Michigan in March 2002 and in Indiana in September 2002; Indiana also implemented an antihypertensive stepwise-therapy requirement in July 2003. Our study cohort included individuals aged ≥18 years in Michigan and Indiana who were continuously enrolled in both Medicaid and Medicare from July 2000 through September 2003. Claims data were obtained from the Centers for Medicare and Medicaid Services. We included all antihypertensive medications, including diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, β-blockers, α-blockers, and angiotcnsin II receptor blockers. We used interrupted time-series analysis to study Policy-related changes in the total number and cost of antihypertensive prescriptions. Results: Overall, 38,684 enrollees in Michigan and 29,463 in Indiana met our inclusion criteria. Slightly more than half of our cohort in both states was female (53.29%in Michigan and 56.32%in Indiana). In Michigan, 20.23% of patients were aged ≥65 years; 77.44% were white, 20.11% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. In Indiana, 20.07% were aged ≥65 years; 84.93% were white, 13.64% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. The implementation of both policies was associated with large and immediate reductions in the use of nonpreferred medications: 83.33% reduction in the use of such drugs in Michigan (-84.30 prescriptions per 1000 enrollees per month; P P P P = 0.04) and 1.82% in Indiana ( P = 0.02). Implementation of the policies was also associated with reductions in pharmacy reimbursement of $616,572.43 in Michigan and $868,265.97 in Indiana in the first postPolicy year. Conclusions: Prior Authorization was associated with lower use of nonpreferred antihypertensive drugs that was largely offset by increases in the use of preferred drugs. The possible clinical consequences of Policyinduced drug switching for individual patients remain unknown because the present study did not include access to medical record data. Further research is needed to establish whether large-scale switches in medicines following the inception of prior-Authorization policies have any long-term health effects.
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unintended impacts of a medicaid prior Authorization Policy on access to medications for bipolar illness
Medical Care, 2010Co-Authors: Christine Y Lu, Stephen B Soumerai, Fang Zhang, Dennis Rossdegnan, Alyce S AdamsAbstract:Objectives:Prior Authorization policies (PA) are widely used to control psychotropic medication costs by state Medicaid programs and Medicare Part D plans. The objective of this study was to examine the impact of a Maine Medicaid PA Policy on initiation and switching of anticonvulsant and atypical a
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prior Authorization for antidepressants in medicaid effects among disabled dual enrollees
JAMA Internal Medicine, 2009Co-Authors: Alyce S Adams, Robert F Lecates, Amy J Graves, Daniel Gilden, Thomas J Mclaughlin, Connie Mah Trinacty, Christine Y Lu, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization is a popular, but understudied, strategy for reducing medication costs. We evaluated the impact of a controversial prior Authorization Policy in Michigan Medicaid on antidepressant use and health outcomes among dual Medicaid and Medicare enrollees with a Social Security Disability Insurance designation of permanent disability. Methods We linked Medicaid and Medicare (2000-2003) claims for dual enrollees in Michigan and a comparison state, Indiana. Using interrupted time-series and longitudinal data analysis, we estimated the impact of the Policy on antidepressant medication use, treatment initiation, disruptions in therapy, and adverse health events among continuously enrolled (Michigan, n = 28 798; Indiana, n = 21 769) and newly treated (Michigan, n = 3671; Indiana, n = 2400) patients. Results In Michigan, the proportion of patients starting nonpreferred agents declined from 53% prePolicy to 20% postPolicy. The prior Authorization Policy was associated with a small sustained decrease in therapy initiation overall (9 per 10 000 population; P = .007). We also observed a short-term increase in switching among established users of nonpreferred agents overall (risk ratio, 2.88; 95% confidence interval, 1.87-4.42) and among those with depression (2.04; 1.22-3.42). However, we found no evidence of increased disruptions in treatment or adverse events (ie, hospitalization, emergency department use) among newly treated patients. Conclusions Prior Authorization was associated with increased use of preferred agents with no evidence of disruptions in therapy or adverse health events among new users. However, unintended effects on treatment initiation and switching among patients already taking the drug were also observed, lending support to the state's previous decision to discontinue prior approval for antidepressants in 2003.
Dennis Rossdegnan - One of the best experts on this subject based on the ideXlab platform.
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association between prior Authorization for psychiatric medications and use of health services among medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization policies are commonly used by Medicaid programs to control psychotropic drug expenditures. This study examined the association of a prior-Authorization Policy for atypical antipsychotic and anticonvulsant agents with medication discontinuation and use of health services among patients with bipolar disorder.
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association between prior Authorization for medications and health service use by medicaid patients with bipolar disorder
Psychiatric Services, 2011Co-Authors: Christine Y Lu, Carl Salzman, Yuting Zhang, Alyce S Adams, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Objective:This study examined the association between a Medicaid prior-Authorization Policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. Methods:A pre-post design with a historical comparison group was used to analyze Maine Medicaid and Medicare claims data. A total of 946 newly treated patients were identified during the eight-month Policy (July 2003–February 2004), and a comparison group of 1,014 was identified from the prePolicy period (July 2002–February 2003). Patients were stratified by number of visits to community mental health centers (CMHCs) before medication initiation (proxy for illness severity): CMHC attenders, at least two visits; nonattenders, fewer than two. Changes in rates of medication discontinuation and outpatient, emergency room, and hospital visits were estimated. Results:Compared with nonattenders, at baseline CMHC attenders had substantially higher rates of comorbid mental di...
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impact of two medicaid prior Authorization policies on antihypertensive use and costs among michigan and indiana residents dually enrolled in medicaid and medicare results of a longitudinal population based study
Clinical Therapeutics, 2010Co-Authors: Stephen B Soumerai, Robert F Lecates, Amy J Graves, Christine Y Lu, Alyce S Adams, Fang Zhang, Dennis RossdegnanAbstract:Abstract Background: In response to rising pharmaceutical costs, many state Medicaid programs have implemented policies requiring prior Authorization for high-cost medications, even for established users. However, little is known about the impact of these policies on the use of antihypertensive medicines in the United States. Objective: The aim of this longitudinal, population-based study was to assess comprehensive priorAuthorization programs for antihypertensives on drug use and costs in a vulnerable Medicaid population in Michigan and Indiana. Methods: A prior-Authorization Policy for antihypertensives was implemented in Michigan in March 2002 and in Indiana in September 2002; Indiana also implemented an antihypertensive stepwise-therapy requirement in July 2003. Our study cohort included individuals aged ≥18 years in Michigan and Indiana who were continuously enrolled in both Medicaid and Medicare from July 2000 through September 2003. Claims data were obtained from the Centers for Medicare and Medicaid Services. We included all antihypertensive medications, including diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, β-blockers, α-blockers, and angiotcnsin II receptor blockers. We used interrupted time-series analysis to study Policy-related changes in the total number and cost of antihypertensive prescriptions. Results: Overall, 38,684 enrollees in Michigan and 29,463 in Indiana met our inclusion criteria. Slightly more than half of our cohort in both states was female (53.29%in Michigan and 56.32%in Indiana). In Michigan, 20.23% of patients were aged ≥65 years; 77.44% were white, 20.11% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. In Indiana, 20.07% were aged ≥65 years; 84.93% were white, 13.64% were black, and the remainder were Hispanic, Native American, Asian, or of other or unknown race. The implementation of both policies was associated with large and immediate reductions in the use of nonpreferred medications: 83.33% reduction in the use of such drugs in Michigan (-84.30 prescriptions per 1000 enrollees per month; P P P P = 0.04) and 1.82% in Indiana ( P = 0.02). Implementation of the policies was also associated with reductions in pharmacy reimbursement of $616,572.43 in Michigan and $868,265.97 in Indiana in the first postPolicy year. Conclusions: Prior Authorization was associated with lower use of nonpreferred antihypertensive drugs that was largely offset by increases in the use of preferred drugs. The possible clinical consequences of Policyinduced drug switching for individual patients remain unknown because the present study did not include access to medical record data. Further research is needed to establish whether large-scale switches in medicines following the inception of prior-Authorization policies have any long-term health effects.
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unintended impacts of a medicaid prior Authorization Policy on access to medications for bipolar illness
Medical Care, 2010Co-Authors: Christine Y Lu, Stephen B Soumerai, Fang Zhang, Dennis Rossdegnan, Alyce S AdamsAbstract:Objectives:Prior Authorization policies (PA) are widely used to control psychotropic medication costs by state Medicaid programs and Medicare Part D plans. The objective of this study was to examine the impact of a Maine Medicaid PA Policy on initiation and switching of anticonvulsant and atypical a
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prior Authorization for antidepressants in medicaid effects among disabled dual enrollees
JAMA Internal Medicine, 2009Co-Authors: Alyce S Adams, Robert F Lecates, Amy J Graves, Daniel Gilden, Thomas J Mclaughlin, Connie Mah Trinacty, Christine Y Lu, Fang Zhang, Dennis Rossdegnan, Stephen B SoumeraiAbstract:Background Prior Authorization is a popular, but understudied, strategy for reducing medication costs. We evaluated the impact of a controversial prior Authorization Policy in Michigan Medicaid on antidepressant use and health outcomes among dual Medicaid and Medicare enrollees with a Social Security Disability Insurance designation of permanent disability. Methods We linked Medicaid and Medicare (2000-2003) claims for dual enrollees in Michigan and a comparison state, Indiana. Using interrupted time-series and longitudinal data analysis, we estimated the impact of the Policy on antidepressant medication use, treatment initiation, disruptions in therapy, and adverse health events among continuously enrolled (Michigan, n = 28 798; Indiana, n = 21 769) and newly treated (Michigan, n = 3671; Indiana, n = 2400) patients. Results In Michigan, the proportion of patients starting nonpreferred agents declined from 53% prePolicy to 20% postPolicy. The prior Authorization Policy was associated with a small sustained decrease in therapy initiation overall (9 per 10 000 population; P = .007). We also observed a short-term increase in switching among established users of nonpreferred agents overall (risk ratio, 2.88; 95% confidence interval, 1.87-4.42) and among those with depression (2.04; 1.22-3.42). However, we found no evidence of increased disruptions in treatment or adverse events (ie, hospitalization, emergency department use) among newly treated patients. Conclusions Prior Authorization was associated with increased use of preferred agents with no evidence of disruptions in therapy or adverse health events among new users. However, unintended effects on treatment initiation and switching among patients already taking the drug were also observed, lending support to the state's previous decision to discontinue prior approval for antidepressants in 2003.
