Impact of Prior Approval for Antidepressants in Medicaid

虽然很少有人知道它的有效性作为一个成本控制政策，大多数国家的医疗补助计划已经制定了事先授权（PA）之前，分配特定的药物，以阻止使用相对更昂贵的药物。该项目将研究2002年3月在密歇根州使用事先授权对同时参加医疗保险的残疾医疗补助计划参加者使用抗抑郁药（AD）和其他保健服务及其费用的影响。抗抑郁药的谨慎选择和剂量，有时在初始治疗失败后，可以提高应答率，增加依从性，减少可能的药物不良事件，并改善长期健康结果。这对于患有精神和身体疾病的人来说尤其如此。以前没有研究评估过事先授权对使用抗抑郁药物或非药物健康服务的影响。使用多年（1999-2004年）的医疗补助和医疗保险索赔数据，我们将评估密歇根州（MI）PA政策施加的行政障碍是否导致意外结果，如 减少使用抗抑郁药，缩短治疗时间，增加AD-药物相互作用的风险，或增加使用其他更昂贵的医疗保健服务。研究人群将包括18-64岁的社区居住的永久性残疾人按服务收费的MI Medicaid登记者。我们将使用中断的时间序列设计来控制密歇根州（MI）和印第安纳州（IN）相同识别的对照队列中药物和卫生服务使用的政策前趋势，该队列将AD药物从其先前的授权计划中排除。大约32，625名和39，375名入组者将分别满足MI和IN的研究标准，以纳入I期分析的趋势和预测因素。 基线时抗抑郁药使用情况。II期和III期分析将检查该政策对抗抑郁药物使用、药物相互作用发生率、其他医疗服务使用和总医疗费用的影响。我们将II期和III期分析限制在密歇根州PA政策实施前后12个月内开始抗抑郁治疗的患者（N约等于MI：5，758; IN：6，950）。所有分析将按残疾类型（精神、身体、发育）分层。

Although little is known about its effectiveness as a cost containment policy, most state Medicaid programs have instituted prior authorization (PA) before dispensing specific drugs to discourage the use of relatively more expensive medications. This project will examine the impact of the use of prior authorization in Michigan in March 2002 on the use and costs of antidepressants (AD) and other health services by disabled Medicaid enrollees who are also enrolled in Medicare. Careful selection and dosing of antidepressant agents, sometimes after initial treatment failures, can improve response rates, increase compliance, decrease possible adverse drug events, and improve long-term health outcomes. This is particularly true for individuals with comorbid mental and physical illness. No previous study has evaluated the effects of prior authorization on use of antidepressant medications or non-drug health services. Using multiple years (1999-2004) of Medicaid and Medicare claims data, we will evaluate whether the administrative barriers imposed by the PA policy in Michigan (Ml) resulted in unintended outcomes such as reductions in the use of antidepressant agents, reduced duration of treatment, increased risk of AD-drug interactions, or an increase in the use of other, more expensive, health care services. The study population will consist of community-dwelling permanently disabled fee-for-service Ml Medicaid enrollees aged 18-64. We will use an interrupted time series design to control for pre-policy trends in use of medications and health services in Michigan (Ml) and in an identically identified control cohort in Indiana (IN), which excluded AD medications from its prior authorization program. Approximately 32,625 and 39,375 enrollees will meet the study criteria in Ml and IN, respectively, for inclusion in the Phase I analyses of trends in and predictors of antidepressant use at baseline. The analyses for Phases II and III will examine the impact of the policy on antidepressant drug use, incidence of drug-drug interactions, use of other health care services, and total health care costs. We will restrict the analyses in Phases II and III to patients who initiated antidepressant therapy in the 12 months before and after the implementation of the PA policy in Michigan (N equals approximately MI:5,758; IN:6,950). All analyses will be stratified by type of disability (mental, physical, developmental).