Prior authorization policies in Medicaid programs: The importance of study design and analysis on findings and outcomes from research
Prior authorization policies in Medicaid programs: The importance of study design and analysis on findings and outcomes from research
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DOI：
10.1016/j.sapharm.2015.04.003
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发表时间：
2016-01-01
影响因子：
3.9
通讯作者：
Harrison, Donald
中科院分区：
文献类型：
--
作者：
Keast, Shellie L.;Farmer, Kevin;Harrison, Donald
美国针对医疗贫困者的国家医疗补助计划致力于以有限的预算提供优质的医疗保健服务。经常使用的成本管理策略是服务或处方药的事先授权。该战略的目标是以最有效的方式为特定州医疗补助计划塑造药品市场份额，就像商业管理医疗组织一样。由于医疗补助所服务的人群在过去主要由健康状况脆弱的个人组成，因此这些政策经常受到审查。如果这些政策未以适当的方式执行或严重限制服务，则可能会出现意想不到的后果。用于政策实施研究的数据容易出现偏态、多模态等问题。之前已经发布了有关分析这些数据时的最佳实践的指南。这些指南用于回顾有关医疗补助事先授权的当前文献。进一步讨论的是其他特征，例如研究的治疗领域和确定的结果。最后，还考虑了在审查个别政策时考虑州特定特征的重要性以及这些结果对其他计划的有用性。 (C) 2016 Elsevier Inc. 保留所有权利。
U.S. State Medicaid programs for the medically indigent strive to deliver quality health care services with limited budgets. An often used cost management strategy is prior authorization of services or prescription medications. The goal of this strategy is to shape the pharmaceutical market share in the most efficient manner for the particular state Medicaid program, much like commercial managed care organizations. These policies are often scrutinized due to the population Medicaid serves, which in the past was largely composed of individuals with vulnerable health status. Unintended consequences can occur if these policies are not carried out in an appropriate manner or if they greatly restrict services. The data used for policy implementation research is prone to certain problems such as skewness and multimodality. Previous guidelines have been published regarding the best practices when analyzing these data. These guidelines were used to review the current body of literature regarding prior authorization in Medicaid. Further discussed are additional characteristics such as therapeutic areas researched and the outcomes identified. Finally, the importance of considering state-specific characteristics when reviewing individual policies and the usefulness of these results for other programs are also considered. (C) 2016 Elsevier Inc. All rights reserved.