Effect of a Restrictive Formulary on Low Income Children

描述（由申请人提供）：面对快速上涨的处方药成本，公共和私人健康保险计划需要管理这些成本，同时仍然提供必要的处方药治疗。爱荷华州儿童健康保险计划（SCHIP）的一家主要保险公司实施了一项限制性处方集，除少数例外情况外，仅涵盖非专利处方药。处方集将改变处方模式，但尚不清楚这种变化是否会影响其他医疗保健结果。主要研究者的长期目标是确定处方药获益管理策略对医疗保健成本和结局的影响。该项目的具体目标是：1）通过比较2002年7月1日实施限制性处方集之前一年和之后一年半的抗抑郁药使用和健康结果，确定爱荷华州SCHIP的限制性处方药处方集对抑郁症儿童的影响。2)通过比较爱荷华州SCHIP、私人保险儿童对照组和爱荷华州医疗补助计划儿童对照组在2002年7月1日实施限制性处方集前一年和一年半后的抗抑郁药使用和健康结局，控制抑郁症治疗的历史趋势。本研究为回顾性研究，采用前测、后测和对照组设计。使用保险公司和医疗补助的索赔数据，各种措施的抗抑郁药的使用和健康结果将被检查之前和之后的限制性处方集在HAWK-I组实施。这些变量包括：抗抑郁药索赔率，抗抑郁药使用率，抗抑郁药 治疗类别利用率、与抑郁症相关的住院人数、与抑郁症相关的医生就诊人数以及与抑郁症相关的其他医疗保健索赔人数。工具变量分析将被用来检查的影响，在抗抑郁药处方模式所造成的限制性处方集对医疗保健成本的变化。

DESCRIPTION (provided by applicant): Faced with rapidly rising prescription drug costs, public and private health insurance programs need to manage these costs while still providing access to necessary prescription drug therapy. A major insurer for the Iowa State Children's Health Insurance Program (SCHIP) has implemented a restrictive formulary that with a few exceptions, only covers generic prescription drugs. The formulary will change prescribing patterns, but it is not known whether this change will affect other health care outcomes. The long term goal of the principal investigator is to determine the effect of prescription drug benefit management strategies on health care costs and outcomes. The specific aims of this project are: 1) Determine the effect of the Iowa SCHIP's restrictive prescription drug formulary on children with depression by comparing antidepressant utilization and health outcomes during the year before and the one and a half years after the restrictive formulary was implemented on July 1, 2002. 2) Control for historical trends in depression treatment by comparing antidepressant utilization and health outcomes between Iowa SCHIP, a comparison group of privately insured children and a comparison group of children in the Iowa Medicaid program during the year before and the one and a half years after the restrictive formulary was implemented on July 1, 2002. The study is retrospective and has a pre-test, post-test with comparison group design. Using insurer and Medicaid claims data, various measures of antidepressant utilization and health outcomes will be examined before and after the restrictive formulary was implemented in the HAWK-I group. These variables include: antidepressant claims rate, generic antidepressant utilization rate, antidepressant therapeutic class utilization rate, number of inpatient admissions related to depression, number of physician visits related to depression and number of other health care claims related to depression. Instrumental variable analysis will be used to examine the effect of changes in antidepressant prescribing patterns caused by the restrictive formulary on health care costs.