Impact of Prior Approval for Antidepressants in Medicaid

尽管人们对其作为成本控制政策的有效性知之甚少，但大多数州的医疗补助计划在分发特定药物之前都建立了事先授权(PA)，以阻止使用相对昂贵的药物。该项目将研究2002年3月在密歇根州使用预先授权对参加联邦医疗保险的残疾医疗补助参与者使用抗抑郁药(AD)和其他健康服务的影响。仔细选择和剂量抗抑郁药物，有时是在最初的治疗失败后，可以提高应答率，增加依从性，减少可能的不良药物事件，并改善长期健康结果。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)的Medicaid和Medicare索赔数据，我们将评估密歇根州PA政策施加的行政障碍是否导致了意外结果，如 减少抗抑郁药的使用，缩短治疗时间，增加AD与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。研究人群将包括社区居住的永久残疾人服务收费ML 18岁的医疗补助参与者-。我们将使用中断时间序列设计来控制密歇根州(ML)和印第安纳州(IN)相同识别的控制队列中药物和医疗服务使用的政策前趋势，该队列将AD药物排除在其先前的授权计划之外。大约32,625名和39,375名参与者将分别符合研究标准，即ML和IN，以便纳入第一阶段对以下方面的趋势和预测因素的分析 基线使用抗抑郁药。第二阶段和第三阶段的分析将审查该政策对抗抑郁药物使用、药物与药物相互作用的发生率、其他医疗保健服务的使用以及医疗保健总成本的影响。我们将把第二阶段和第三阶段的分析限制在密歇根州PA政策实施之前和之后12个月内开始抗抑郁治疗的患者(N约等于MI：5758；IN：6950)。所有分析将按残疾类型(精神、身体、发育)进行分层。

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).