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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, Yuting Zhang, Alyce S Adams, Dennis Rossdegnan, Fang Zhang, Carl Salzman, 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, Yuting Zhang, Alyce S Adams, Dennis Rossdegnan, Fang Zhang, Carl Salzman, 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 Prior Authorization on the use and costs of lipid lowering medications among michigan and indiana dual enrollees in medicaid and medicare results of a longitudinal population based study
Clinical Therapeutics, 2011Co-Authors: Christine Y Lu, Dennis Rossdegnan, Fang Zhang, Stephen B Soumerai, Robert F Lecates, Amy J Graves, Alyce S AdamsAbstract:Background 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.
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Prior Authorization for antidepressants in medicaid effects among disabled dual enrollees
JAMA Internal Medicine, 2009Co-Authors: Alyce S Adams, Dennis Rossdegnan, Fang Zhang, Robert F Lecates, Amy J Graves, Daniel Gilden, Thomas J Mclaughlin, Christine Y Lu, Connie Mah Trinacty, 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.
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effects of Prior Authorization on medication discontinuation among medicaid beneficiaries with bipolar disorder
Psychiatric Services, 2009Co-Authors: Yuting Zhang, Alyce S Adams, Dennis Rossdegnan, Fang Zhang, Stephen B SoumeraiAbstract:Objective: Few data exist on the cost and quality effects of increased use of Prior-Authorization policies to control psychoactive drug spending among persons with serious mental illness. This study examined the impact of a Prior-Authorization policy in Maine on second-generation antipsychotic and anticonvulsant utilization, discontinuations in therapy, and pharmacy costs among Medicaid beneficiaries with bipolar disorder. Methods: Using Medicaid and Medicare utilization data for 2001–2004, the authors identified 5,336 patients with bipolar disorder in Maine (study state) and 1,376 in New Hampshire (comparison state). With an interrupted time-series and comparison group design, longitudinal changes were measured in second-generation antipsychotic and anticonvulsant use; survival analysis was used to examine treatment discontinuations and rates of switching medications. Results: The Prior-Authorization policy resulted in an 8–percentage point reduction in the prevalence of use of nonpreferred second-generation antipsychotic and anticonvulsant medications (those requiring Prior Authorization) but did not increase use of preferred agents (no Prior Authorization) or rates of switching. The Prior-Authorization policy reduced total pharmacy reimbursements for bipolar disorder by $27 per patient during the eight-month policy period. However, the hazard rate of treatment discontinuation (all bipolar drugs) while the policy was in effect was 2.28 (95% confidence interval=1.36–4.33) higher than during the prepolicy period, with adjustment for trends in the comparison state. Conclusions: The small reduction in pharmacy spending for bipolar treatment after the policy was implemented may have resulted from higher rates of medication discontinuation rather than switching. The findings indicate that the Prior-Authorization policy in Maine may have increased patient risk without appreciable cost savings to the state. (Psychiatric Services 60:520–527, 2009)
Dean T Eurich - One of the best experts on this subject based on the ideXlab platform.
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changes in thiazolidinedione use and outcomes following removal of a Prior Authorization policy controlled time series analysis
Medical Care, 2014Co-Authors: Johnmichael Gamble, Jeffrey A Johnson, Sumit R Majumdar, Finlay A Mcalister, Scot H Simpson, Dean T EurichAbstract:OBJECTIVE: The aim of this study was to assess the impact of removing Prior-Authorization restrictions on the use of thiazolidinediones (TZDs) and outcomes. METHODS: In a controlled interrupted time-series analysis, whereby new users of antidiabetic agents over 65 years of age in adjacent Canadian provinces with different TZD-related policies [Alberta (n = 16,653) and Saskatchewan (n = 6682)] were followed from January 2001 to December 2006. Prior Authorization for TZDs was removed in Alberta (intervention province) in December 2003 (rosiglitazone) and February 2004 (pioglitazone); no policy changes occurred in Saskatchewan (control province). Adjusted differences in percent change between intervention and control provinces were used to estimate policy-attributable effects (PAE) on TZD use within 30 days and 1 year and patient outcomes (composite of all-cause mortality or hospitalization for acute coronary events or heart failure) within 1 year. RESULTS: Mean age was 75 years, 51% were female, and 206,055 antidiabetic prescriptions were dispensed during follow-up. TZD use within 30 days among new users of antidiabetic agents increased almost >10% in Alberta compared with Saskatchewan controls immediately following the policy change: PAE = 9.4%, 95% confidence interval, 7.3%-11.6%. Other less expensive antidiabetic drug use decreased to exactly the same extent, suggesting TZD substitution. Compared with the controls, in Alberta there were no changes in the primary (clinical) composite outcome at 1 year (PAE = 0.31%, 95% confidence interval, -2.8% to +3.4%). CONCLUSIONS: The removal of a Prior-Authorization policy for TZDs was associated with an immediate increase in TZD use but did not impact patient outcomes. In this case, the policy removal shifted drug use to a more expensive drug with less certain clinical benefit.
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evaluating the introduction of a computerized Prior Authorization system on the completeness of drug exposure data
Pharmacoepidemiology and Drug Safety, 2013Co-Authors: Johnmichael Gamble, Jeffrey A Johnson, Sumit R Majumdar, Finlay A Mcalister, Scot H Simpson, Dean T EurichAbstract:Purpose Administrative databases that only capture records for benefit-approved prescriptions may underestimate exposure because they do not capture non-benefit prescriptions. Using a natural experiment, we illustrate the impact of automating a Prior-Authorization policy on the completeness of drug exposure. Methods Using Saskatchewan (Canada) databases, weekly counts of benefit-approved and total prescription records in 2006 for new users of antidiabetic agents were examined across four categories: thiazolidinediones (TZDs), metformin, glyburide, and insulin. On July 1, 2006, Saskatchewan's public drug plan implemented an automated, online-adjudicated, Prior-Authorization process for TZDs; previously, Prior approval was paper based. No such policy changes occurred for other drugs. We estimated the effect of this policy change on drug exposure using interrupted time-series analyses. Results We examined 223 552 prescription records: 19% were for TZDs, 48% for metformin, 20% for glyburide, and 13% for insulin. Prior to automation, there were, on average, 571 benefit-approved TZD records per week; however, the number of benefit-approved TZD records increased immediately after the automated process was introduced by 240 prescriptions per week (95% CI 200–280, p 0.1 for all). Conclusions Automating Prior Authorization for TZDs immediately increased the proportion of captured TZD records, suggesting in our study that one-fifth of TZD exposure was previously misclassified. If replicable, this indicates that even subtle changes in reimbursement policy may affect the validity of drug exposure data. Copyright © 2013 John Wiley & Sons, Ltd.
Michael A Fischer - One of the best experts on this subject based on the ideXlab platform.
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Medicaid's Prior Authorization Program And Access To Atypical Antipsychotic
2020Co-Authors: Jennifer M Polinski, Philip S. Wang, Michael A FischerAbstract:State Medicaid programs use Prior Authorization (PA) to control drug spending by requiring that specific conditions be met before allowing reimbursement. The extent to which PA policies respond to new developments concerning medication safety is not known. In April 2005 the Food and Drug Administration (FDA) issued an advisory describing increased mortality among elderly people with dementia taking atypical antipsychotics. More than a year later, no state had changed its PA policy in response. We discuss the roles of Medicaid and other insurers in responding to emerging drug safety issues and their chal- lenges in weighing drug risks and benefits. (Health Affairs 26, no. 3 (2007): 750-760;
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Prior Authorization for biologic disease modifying antirheumatic drugs a description of us medicaid programs
Arthritis & Rheumatism, 2008Co-Authors: Michael A Fischer, Jennifer M Polinski, Amber Servi, Jessica Agnewblais, Liljana Kaci, Daniel H SolomonAbstract:Objective To evaluate state Medicaid Prior Authorization programs for biologic disease-modifying antirheumatic drugs (DMARDs). Methods We obtained biologic DMARD Prior Authorization policy information from state Medicaid programs. Using aggregate Medicaid drug spending data, we calculated the proportion of DMARD prescriptions and spending attributed to adalimumab and etanercept in 1999 and 2005 and compared the changes in these proportions in states with and without Prior Authorization policies. Infliximab and other infused DMARDs were not included because of substantial missing data. Results Thirty-two states required Prior Authorization for ≥1 biologic DMARD, with wide variation in the specific agents covered and the criteria required for a drug to be authorized. There were 18 states with Prior Authorization requirements for adalimumab or etanercept. States that implemented Prior Authorization for these agents initially had lower use of the targeted medications, but use increased over time to a level similar to that in states that did not have Prior Authorization requirements. Conclusion States vary widely in their implementation of Prior Authorization policies to limit use of biologic DMARDs. Although it appears that these policies may have a short-term effect on the use of targeted medications, this effect does not appear to be sustained. The clinical impact and appropriateness of such policies is not clear from our data and should be studied further.
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medicaid s Prior Authorization program and access to atypical antipsychotic medications
Health Affairs, 2007Co-Authors: Jennifer M Polinski, Philip S. Wang, Michael A FischerAbstract:State Medicaid programs use Prior Authorization (PA) to control drug spending by requiring that specific conditions be met before allowing reimbursement. The extent to which PA policies respond to new developments concerning medication safety is not known. In April 2005 the Food and Drug Administration (FDA) issued an advisory describing increased mortality among elderly people with dementia taking atypical antipsychotics. More than a year later, no state had changed its PA policy in response. We discuss the roles of Medicaid and other insurers in responding to emerging drug safety issues and their challenges in weighing drug risks and benefits.
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impact of medicaid Prior Authorization on angiotensin receptor blockers can policy promote rational prescribing
Health Affairs, 2007Co-Authors: Michael A Fischer, Niteesh K Choudhry, Wolfgang C WinkelmayerAbstract:Prescription drug cost containment is a key health policy Priority. State Medic-aid programs have implemented policies requiring Prior Authorization before paying for angiotensin-receptor blockers (ARBs), a costly class of blood pressure medications. We examined the impact of these policies on drug use. We found that policies using a stepped-therapy approach reduced ARB use by 1.6 percent when first implemented and decreased the subsequent trend in ARB use by 1.3 percent per quarter; alternative approaches were unsuccessful. These findings have important implications for the development of rational drug reimbursement policy under Medicare Part D and other health insurance plans.
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Prior Authorization policies for selective cyclooxygenase 2 inhibitors in medicaid a policy review
Medical Care, 2006Co-Authors: Michael A Fischer, Hailu Cheng, Sebastian Schneeweiss, Jerry Avorn, Daniel H SolomonAbstract:Background: Many state Medicaid programs use Prior Authorization programs to limit spending on cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs (coxibs). However, the evidence base for the Prior Authorization criteria has not been examined previously. Methods: We determined whether Prior Authorization was required for coxibs in state Medicaid programs and collected data on what precise criteria needed to be met for a coxib prescription to be authorized. Prior Authorization criteria were compared to clinical evidence regarding which patients are most likely to benefit from coxibs. Results: By mid-2004, 35 states had implemented Prior Authorization requirements for coxibs. Of 5 major clinical factors that identify patients likely to benefit from coxibs, 18 states (51%) included all 5 factors and 9 states (26%) included 2 or fewer. Most states (33/35; 94%) required a previous trial of nonselective nonsteroidal anti-inflammatory drugs before a coxib would be authorized. Several Prior Authorization programs included factors that had no connection to the clinical evidence. Conclusions: State Medicaid Prior Authorization policies for coxibs are heterogeneous in terms both of the criteria required to obtain a coxib and of the relationship of those criteria to clinical evidence. Development of clinically rational prescription drug policies should be a goal for all health insurers and represents an important Priority for Medicare's prescription drug benefit program.
Theoklis E Zaoutis - One of the best experts on this subject based on the ideXlab platform.
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comparison of Prior Authorization and prospective audit with feedback for antimicrobial stewardship
Infection Control and Hospital Epidemiology, 2014Co-Authors: Jimish Mehta, Kevin Haynes, Paul E Wileyto, Jeffrey S Gerber, Daniel Timko, Steven Morgan, Shawn Binkley, Neil O Fishman, Ebbing Lautenbach, Theoklis E ZaoutisAbstract:Antimicrobial stewardship programs (ASPs) are multifaceted, interdisciplinary approaches to optimize anti-infective therapy and address emerging resistant pathogens.1,2 Guidelines for stewardship identify several potential strategies, including 2 core “active” methods: formulary restriction with Prior Authorization and prospective audit with feedback to prescribers. Prior Authorization permits use of select agents after approval from an ASP team member, whereas prospective audit with feedback utilizes postprescriptive reviews conducted by the ASP to recommend changes in agent selection, dosing, or duration of therapy.2,3 Published literature supports both methods as being effective strategies to decrease antimicrobial exposure, decrease costs, and improve clinical outcomes.4–9 However, because these 2 ASP methods have not been compared, the most effective approach remains unclear.2,10 Implementation of ASPs is increasingly common, and widespread adoption of stewardship interventions has been promoted by professional and governmental organizations.2,11,12 This study aims to compare an ASP based on Prior Authorization alone to one combining Prior Authorization and prospective audit with feedback.
Johnmichael Gamble - One of the best experts on this subject based on the ideXlab platform.
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changes in thiazolidinedione use and outcomes following removal of a Prior Authorization policy controlled time series analysis
Medical Care, 2014Co-Authors: Johnmichael Gamble, Jeffrey A Johnson, Sumit R Majumdar, Finlay A Mcalister, Scot H Simpson, Dean T EurichAbstract:OBJECTIVE: The aim of this study was to assess the impact of removing Prior-Authorization restrictions on the use of thiazolidinediones (TZDs) and outcomes. METHODS: In a controlled interrupted time-series analysis, whereby new users of antidiabetic agents over 65 years of age in adjacent Canadian provinces with different TZD-related policies [Alberta (n = 16,653) and Saskatchewan (n = 6682)] were followed from January 2001 to December 2006. Prior Authorization for TZDs was removed in Alberta (intervention province) in December 2003 (rosiglitazone) and February 2004 (pioglitazone); no policy changes occurred in Saskatchewan (control province). Adjusted differences in percent change between intervention and control provinces were used to estimate policy-attributable effects (PAE) on TZD use within 30 days and 1 year and patient outcomes (composite of all-cause mortality or hospitalization for acute coronary events or heart failure) within 1 year. RESULTS: Mean age was 75 years, 51% were female, and 206,055 antidiabetic prescriptions were dispensed during follow-up. TZD use within 30 days among new users of antidiabetic agents increased almost >10% in Alberta compared with Saskatchewan controls immediately following the policy change: PAE = 9.4%, 95% confidence interval, 7.3%-11.6%. Other less expensive antidiabetic drug use decreased to exactly the same extent, suggesting TZD substitution. Compared with the controls, in Alberta there were no changes in the primary (clinical) composite outcome at 1 year (PAE = 0.31%, 95% confidence interval, -2.8% to +3.4%). CONCLUSIONS: The removal of a Prior-Authorization policy for TZDs was associated with an immediate increase in TZD use but did not impact patient outcomes. In this case, the policy removal shifted drug use to a more expensive drug with less certain clinical benefit.
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evaluating the introduction of a computerized Prior Authorization system on the completeness of drug exposure data
Pharmacoepidemiology and Drug Safety, 2013Co-Authors: Johnmichael Gamble, Jeffrey A Johnson, Sumit R Majumdar, Finlay A Mcalister, Scot H Simpson, Dean T EurichAbstract:Purpose Administrative databases that only capture records for benefit-approved prescriptions may underestimate exposure because they do not capture non-benefit prescriptions. Using a natural experiment, we illustrate the impact of automating a Prior-Authorization policy on the completeness of drug exposure. Methods Using Saskatchewan (Canada) databases, weekly counts of benefit-approved and total prescription records in 2006 for new users of antidiabetic agents were examined across four categories: thiazolidinediones (TZDs), metformin, glyburide, and insulin. On July 1, 2006, Saskatchewan's public drug plan implemented an automated, online-adjudicated, Prior-Authorization process for TZDs; previously, Prior approval was paper based. No such policy changes occurred for other drugs. We estimated the effect of this policy change on drug exposure using interrupted time-series analyses. Results We examined 223 552 prescription records: 19% were for TZDs, 48% for metformin, 20% for glyburide, and 13% for insulin. Prior to automation, there were, on average, 571 benefit-approved TZD records per week; however, the number of benefit-approved TZD records increased immediately after the automated process was introduced by 240 prescriptions per week (95% CI 200–280, p 0.1 for all). Conclusions Automating Prior Authorization for TZDs immediately increased the proportion of captured TZD records, suggesting in our study that one-fifth of TZD exposure was previously misclassified. If replicable, this indicates that even subtle changes in reimbursement policy may affect the validity of drug exposure data. Copyright © 2013 John Wiley & Sons, Ltd.