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Healthy Skepticism Library item: 7713

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

 

Publication type: Journal Article

Roughead EE, Zhang F, Ross-Degnan D, Soumerai S.
Differential effect of early or late implementation of prior authorization policies on the use of Cox II inhibitors.
Med Care 2006 Apr; 44:(4):378-82
http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00005650-200604000-00013


Abstract:

BACKGROUND: State Medicaid programs introduce many types of prescribing restrictions to manage pharmaceutical use and expenditure. Little is known about the differential effect of implementing prior authorization (PA) policies at market entry versus waiting until several years later when prescribing behavior may already be established.

OBJECTIVES: We sought to examine the impact on overall use of Cox II inhibitors of PA policies implemented at market entry versus at least 2 years after market entry.

RESEARCH DESIGN: We quantified Cox II inhibitor and nonselective nonsteroidal anti-inflammatory drug (NSAID) utilization for state Medicaid programs from January 1996 to September 2003. We used generalized estimating equations, Tukey’s studentized range test and segmented linear regression on state Medicaid programs to determine the significance of changes in medication use.

MEASURES: The primary end point was the number of defined daily doses (DDD) per 1000 population per day.

RESULTS: Six states implementing prescribing restrictions for Cox II inhibitors at market entry had the lowest rates of uptake, averaging 10.9 DDD/1000/d. Twelve states adopting restrictions more than 2 years after market entry experienced declines in use from 23.0 DDD/1000/d before to 13.9 DDD/1000/d after the restrictions (P < 0.01). The 17 states that had never restricted access had the highest utilization, averaging 29.0 DDD/1000/d.

CONCLUSION: Implementing prescribing restrictions at market entry of Cox II inhibitors was effective in restricting uptake. Despite the difficulty in changing well-established prescribing patterns, utilization in states implementing policies 2 years after market entry approached that of the early adopting states within 1 year. Clinical outcomes of such policies remain unknown.

Keywords:
Publication Types: Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. MeSH Terms: Anti-Ulcer Agents/therapeutic use Cyclooxygenase 2 Inhibitors/economics* Cyclooxygenase 2 Inhibitors/therapeutic use* Drug Utilization/statistics & numerical data* Health Plan Implementation/economics Health Policy* Humans Medicaid/economics* State Health Plans/economics United States/epidemiology Substances: Anti-Ulcer Agents Cyclooxygenase 2 Inhibitors

 

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Far too large a section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science...
The blind faith which some men have in medicines illustrates too often the greatest of all human capacities - the capacity for self deception...
Some one will say, Is this all your science has to tell us? Is this the outcome of decades of good clinical work, of patient study of the disease, of anxious trial in such good faith of so many drugs? Give us back the childlike trust of the fathers in antimony and in the lancet rather than this cold nihilism. Not at all! Let us accept the truth, however unpleasant it may be, and with the death rate staring us in the face, let us not be deceived with vain fancies...
we need a stern, iconoclastic spirit which leads, not to nihilism, but to an active skepticism - not the passive skepticism, born of despair, but the active skepticism born of a knowledge that recognizes its limitations and knows full well that only in this attitude of mind can true progress be made.
- William Osler 1909