Prior Authorization for Antidepressants in Medicaid Effects Among Disabled Dual Enrollees

被引:36
作者
Adams, Alyce S. [1 ,2 ,3 ]
Zhang, Fang [2 ,3 ]
LeCates, Robert F. [2 ,3 ]
Graves, Amy Johnson [2 ,3 ]
Ross-Degnan, Dennis [2 ,3 ]
Gilden, Daniel [4 ]
McLaughlin, Thomas J. [5 ]
Lu, Christine [2 ,3 ]
Trinacty, Connie M. [2 ,3 ]
Soumerai, Stephen B. [2 ,3 ]
机构
[1] Kaiser Permanente, Div Res, Oakland, CA USA
[2] Harvard Univ, Sch Med, Dept Ambulatory Care & Prevent, Boston, MA USA
[3] Harvard Pilgrim Hlth Care, Boston, MA USA
[4] Jen Associates Inc, Cambridge, MA USA
[5] Univ Massachusetts, Sch Med, Dept Pediat & Psychiat, Worcester, MA USA
关键词
INTERRUPTED TIME-SERIES; PART-D; DRUGS; CARE; DISORDERS; SCHIZOPHRENIA; BENEFITS; EFFICACY; THERAPY; IMPACT;
D O I
10.1001/archinternmed.2009.39
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 switchingamongpatients already taking the drug were also observed, lending support to the state's previous decision to discontinue prior approval for antidepressants in 2003.
引用
收藏
页码:750 / 756
页数:7
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