Impact of Medicaid prior authorization requirement for COX-2 inhibitor drugs in Nebraska

Health Services Research
Mark V Siracuse, Phillip J Vuchetich

Abstract

Determine the impact of a Prior Authorization Requirement (PAR) program on Medicaid pharmacy expenditures and utilization. Prescription claims for Nebraska Medicaid recipients who received a cyclooxygenase-2 (COX-2) inhibitor, a nonselective nonsteroidal antiinflammatory (NSAID) drug, or other pain relievers between July 2001 and June 2003. STUDY DESIGN AND DATA COLLECTION/EXTRACTION: This was a retrospective cross-sectional study with a 12-month pre-PAR implementation period and a 12-month post-PAR implementation period. Pharmacy transactions for COX-2 inhibitors, NSAIDs, other pain relievers, and gastroprotectants were identified by their National Drug Code (NDC) in a Microsoft SQL query. The PAR was designed to approve COX-2 inhibitor use only for recipients at high risk of GI side effects while restricting access to those patients at low to moderate risk of GI side effects. One year following implementation of the PAR, overall expenditures on COX-2 inhibitors for Nebraska Medicaid dropped 50 percent. The overall impact on pharmacy expenditures, including NSAIDs, pain relief medications, and gastroprotectants when necessary to relieve gastrointestinal (GI) side effects, for those recipients who switched from a COX-2 inhibito...Continue Reading

References

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Citations

Mar 10, 2012·BMC Health Services Research·Francisco Javier GarjónJose Ramón Loayssa
May 20, 2015·Research in Social & Administrative Pharmacy : RSAP·Shellie L KeastDonald Harrison
Oct 26, 2016·Paediatric Anaesthesia·Margaret J LivingstoneTonya M Palermo
Jul 25, 2017·Journal of Managed Care & Specialty Pharmacy·Yujin ParkJohn Ko

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