Healthy Skepticism Library item: 7712

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Publication type: Journal Article

Fischer MA, Cheng H, Schneeweiss S, Avorn J, Solomon DH.
Prior authorization policies for selective cyclooxygenase-2 inhibitors in Medicaid: a policy review.
Med Care 2006 Jul; 44:(7):658-63
http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00005650-200607000-00007

Abstract:

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.

Keywords:
Publication Types: Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S. MeSH Terms: Anti-Inflammatory Agents, Non-Steroidal/administration & dosage Cost Control Cyclooxygenase 2 Inhibitors/administration & dosage* Cyclooxygenase 2 Inhibitors/adverse effects Cyclooxygenase 2 Inhibitors/economics Glucocorticoids/administration & dosage Health Policy/economics* Humans Medicaid/economics Medicaid/organization & administration* Polypharmacy Reimbursement Mechanisms/economics Reimbursement Mechanisms/organization & administration* Risk Factors United States Warfarin/administration & dosage Substances: Anti-Inflammatory Agents, Non-Steroidal Cyclooxygenase 2 Inhibitors Glucocorticoids Warfarin