Examining the Impact of Medicaid's Prior Authorization Requirements for Tobacco Cessation Medications on Tobacco Cessation Medication Prescriptions

项目总结/摘要 增加获得戒烟药物的机会是美国卫生政策减少吸烟的战略的一个关键部分。 吸烟，特别是低收入吸烟者，他们不太可能使用戒烟药物， 高收入的吸烟者。鉴于《平价医疗法案》要求医疗补助计划涵盖烟草， 戒烟药物，医疗补助覆盖范围赠款登记者获得戒烟药物， 原则上，但超过三分之二的州医疗补助计划要求医生事先获得授权， 在处方戒烟药物之前，计划管理员。虽然事先授权 需求的支持者认为，要求事先授权可以确保适当的和具有成本效益的 开处方而不减少获得有用药物的机会，即使是很小的处方障碍也有可能 对处方行为和药物获取有很大的影响。公共卫生领导人呼吁取消 获得戒烟药物的障碍，但目前尚不清楚是否需要事先授权 有意义地减少这些药物的总体使用，或者相反，如果它确保适当使用而不减少 更广泛地获取，正如其倡导者所主张的那样。该项目旨在评估先前的影响。 通过使用以下详细数据，了解医疗补助中关于使用戒烟药物的授权要求 医疗保健声称研究科罗拉多的医疗补助计划，取消其事先授权的要求， 2018年的戒烟药物。拟议项目的一个主要目标是估计 科罗拉多取消对整体戒烟处方和相关处方的事先授权要求 治疗。第二个目标是估计取消事先授权的不同影响 不同人口群体的需求。然后，该项目建议使用估计数进行 额外的分析，以评估医疗补助计划的国家影响，需要事先授权， 戒烟药物。此外，该项目还建议测试先前的异质性效应， 授权要求根据先前的健康状况，以评估索赔的主要影响， 授权要求是为了避免处方，医疗补助计划可以确定为潜在的 不合适实现这些目标将为利益相关者提供信息， 决定是否需要戒烟药物的事先授权，以及 要求事先授权，以建立系统和规则，改善事先授权过程， 戒烟药物。实现这项研究的目标将解决多个研究重点的 国家癌症研究所通过增加对获得循证戒烟障碍的了解 治疗，通过确定战略，以增加使用戒烟治疗的人低 社会经济地位，并提供有关保险公司如何为戒烟做出贡献的见解。

PROJECT SUMMARY/ABSTRACT Increasing access to tobacco cessation medications is a key part of U.S. health policy’s strategy for reducing smoking, especially for low-income smokers, who are less likely to use tobacco cessation medications than high-income smokers are. Given that the Affordable Care Act requires Medicaid programs to cover tobacco cessation medications, Medicaid coverage grants enrollees access to tobacco cessation medications in principle, but over two-thirds of state Medicaid programs require doctors to obtain prior authorization from program administrators before prescribing tobacco cessation medications. While prior authorization requirements’ advocates argue that requiring prior authorization can ensure appropriate and cost-effective prescribing without reducing access to helpful medications, even small prescribing hurdles have the potential to have large impacts on prescribing behavior and medication access. Public health leaders call for removing barriers in access to tobacco cessation medications, but it is not currently known if requiring prior authorization meaningfully reduces overall use of these medications or if it instead ensures appropriate use without reducing access more generally, as its advocates argue. This project proposes to estimate the impact of prior authorization requirements in Medicaid on the use of tobacco cessation medications by using detailed data on health care claims to study Colorado’s Medicaid program removing its prior authorization requirement for tobacco cessation medications in 2018. A primary objective of the proposed project is to estimate the impact of Colorado removing its prior authorization requirement on overall tobacco cessation prescriptions and related treatments. A second objective is to estimate heterogeneous impacts of removing prior authorization requirements for different demographic groups. The project then proposes to use the estimates to conduct additional analyses to assess the national implications of Medicaid programs requiring prior authorization for tobacco cessation medications. In addition, the project proposes to test for heterogeneous effects of prior authorization requirements based on prior health conditions to assess the claim that the main effect of prior authorization requirements is to avoid prescriptions that Medicaid programs could identify as potentially being inappropriate. Achieving these aims will provide stakeholders with information that can be used when making decisions about whether to require prior authorization for tobacco cessation medications and, conditional on requiring prior authorization, to set up systems and rules that improve the prior authorization process for tobacco cessation medications. Achieving the aims of this study will address multiple research priorities of the National Cancer Institute by increasing knowledge about barriers in access to evidenced-based cessation treatments, by identifying strategies to increase the use of cessation treatments for people with low socioeconomic status, and by providing insights into how insurers can contribute to tobacco cessation.