Impact of pharmaceutical prior authorisation policies: A systematic review of the literature

PharmacoEconomics

Volumn 25, Issue 8, 2007, Pages 637-648

  Puig Junoy, Jaume ^a   Moreno Torres, Iván ^a  

^a DEPARTMENT OF ECONOMICS AND BUSINESS   (Spain)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIHISTAMINIC AGENT; ANTIRHEUMATIC AGENT; ANTIULCER AGENT; BENZODIAZEPINE; CARDIOVASCULAR AGENT; CELECOXIB; CIMETIDINE; CYCLOOXYGENASE 2 INHIBITOR; FLUOXETINE; GENERIC DRUG; NONSTEROID ANTIINFLAMMATORY AGENT; PAROXETINE; PROTON PUMP INHIBITOR;

CLINICAL TRIAL; DRUG COST; DRUG USE; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE UTILIZATION; HUMAN; MEDICAID; MEDLINE; OUTCOME ASSESSMENT; PRESCRIPTION; PRIORITY JOURNAL; QUALITY OF LIFE; REVIEW; SYSTEMATIC REVIEW; UNITED STATES;

DRUG AND NARCOTIC CONTROL; DRUG COSTS; DRUG UTILIZATION; HEALTH EXPENDITURES; QUALITY OF LIFE; REIMBURSEMENT MECHANISMS;

EID: 34547212894     PISSN: 11707690     EISSN: None     Source Type: Journal    
DOI: 10.2165/00019053-200725080-00002     Document Type: Review

References (41)

1. OECD. OECD health data 2006: statistics and indicators for 30 countries. Paris: OECD, 2006
2. Kozma CM, Schulz RM, Dickson WM, et al. Economic impact of cost-containment strategies in third party programmes in the US. Pharmacoeconomics 1993; 4: 187-202
3. Carroll NV. How effectively do managed care organizations influence prescribing and dispensing decisions? Am J Manag Care 2002; 8: 1041-54
4. Hamel MB, Epstein AM. Prior authorization programs for controlling drug spending. N Engl J Med 2004; 351: 2156-8
5. Schneeweiss S, Maclure M, Carleton B, et al. Clinical and economic consequences of a reimbursement restriction of nebulised respiratory therapy in adults: direct comparison of randomised and observational evaluations. BMJ 2004; 328 (7439): 560
6. Soumerai SB. Benefits and risks of increasing restrictions on access to costly drugs in Medicaid. Health Aff 2004; 23: 135-46
7. Haga A, Sverre JM. Pricing and reimbursement of pharmaceuticals in Norway. Eur J Health Econ 2002; 3: 215-20
8. Pedersen KM. Pricing and reimbursement of drugs in Denmark. Eur J Health Econ 2003; 4: 60-5
9. Rochaix L. De la Diffculté d'un Arbitrage entre Intérêt Collectif et Int́erêts Individuels: un Dilemme de plus pour le Médecin. Journal d'Economie Médicale 1987; 4: 223-43
10. Rochaix L. The physician as perfect agent: a comment. Soc Sci Med 1998; 47: 355-6
11. Blomqvist A. The doctor as double agent: information asymmetry, health insurance, and medical care. J Health Econ 1991; 10: 411-32
12. Howard RC. The sentinel effect in an outpatient managed care setting. Prof Psychol Res Pr 1998; 29 (3): 262-8
13. Hernandez C, Casas A, Escarrabill J, et al. Home hospitalisation of exacerbated chronic obstructive pulmonary disease patients. Eur Respir J 2003; 21: 58-67
14. Stuart B, Doshi JA, Briesacher B, et al. Impact of prescription coverage on hospital and physician costs: a case study of medicare beneficiaries with chronic obstructive pulmonary disease. Clin Ther 2004; 26: 1688-99
15. Lichtenberg FR, Virabhak S. Pharmaceutical embodied technical progress, longevity, and quality of life: drugs as 'equipment for your health' [working paper 9351]. Cambridge (MA): National Bureau of Economic Research, Inc., 2002
16. Cunningham PJ. Medicaid cost containment and access to prescription drugs. Health Aff 2005; 24: 780-9
17. Risser JA, Vash PD, Nieto L. Does prior authorization of sibutramine improve medication compliance or weight loss? Obes Res 2005; 13: 86-92
18. Meyer CM, Phipps R, Cooper D, et al. Pharmacy benefit forecast for a new interferon beta-1a for the treatment of multiple sclerosis: development of a first-line decision tool for pharmacy-budget planning using administrative claims data. J Manag Care Pharm 2003; 9: 168-74
19. Stacey J, Shaw E, Arledge MD, et al. Pharmacoeconomics modeling of prior-authorization intervention for COX-2 specific inhibitors in a 3-tier copay plan. J Manag Care Pharm 2003; 9: 327-34
20. Wertheimer AI, Santella TM. Effect of prior authorization and formulary limitation in community pharmacy practice and profitability. Drug Benefit Trends 2006; January: 36-49
21. MacKinnon NJ, Kumar R. Prior authorization programs: a critical review of the literature. J Manag Care Pharm 2001; 7: 297-302
22. Bloom BS, Jacobs J. Cost effects of restricting cost-effective therapy. Med Care 1985; 23: 872-80
23. Carroll NV, Smith JC, Berringer RA, et al. Evaluation of an automated system for prior authorization: a COX-2 inhibitor example. Am J Manag Care 2006; 12: 501-8
24. Delate T, Mager DE, Sheth J, et al. Clinical and financial outcomes associated with a proton pump inhibitor prior-authorization program in a Medicaid population. Am J Manag Care 2005; 11: 29-36
25. Fischer MA, Schneeweiss S, Avorn J, et al. Medicaid prior-authorization programs and the use of cyclooxygenase-2 inhibitors. N Engl J Med 2004; 351: 2187-94
26. Gleason PP, Williams C, Hrdy S, et al. Medical and pharmacy expenditures after implementation of a cyclooxygenase-2 inhibitor prior authorization program. Pharmacotherapy 2005; 25: 924-34
27. Hartung DM, Touchette DR, Ketchum KL, et al. Effects of a prior-authorization policy for celecoxib on medical service and prescription drug use in a managed care Medicaid population. Clin Ther 2004; 26: 1518-32
28. Kahan NR, Chinitz DP, Waitman DA, et al. When gatekeepers meet the sentinel: the impact of a prior authorization requirement for cefuroxime on the prescribing behaviour of community-based physicians. Br J Clin Pharmacol 2006; 61: 341-4
29. Kotzan JA, McMillan JA, Jankel CA, et al. Initial impact of a Medicaid prior authorization program for NSAID prescriptions. J Res Pharmaceut Econ 1993; 5: 25-41
30. McCombs JS, Shi L, Stimmel GL, et al. A retrospective analysis of the revocation of prior authorization restrictions and the use of antidepressant medications for treating major depressive disorder. Clin Ther 2002; 24: 1939-59
31. Momani AA, Madhavan SS, Nau DP. Impact of NSAIDs prior authorization policy on patients' QoL. Ann Pharmacother 2002; 36: 1686-91
32. Phillips CR, Larson LN. Evaluating the operational performance and financial effects of a drug prior authorization program. J Manag Care Pharm 1997; 3: 699-706
33. Roughead EE, Zhang F, Ross-Degnan D, et al. Differential effect of early or late implementation of prior authorization policies on the use of Cox II inhibitors. Med Care 2006; 44: 378-82
34. Smalley WE, Griffin MR, Fought RL, et al. Effect of a prior-authorization requirement on the use of nonsteroidal antiinflammatory drugs by Medicaid patients. N Engl J Med 1995; 15: 1612-7
35. Virabhak S, Shinogle JA. Physicians' prescribing responses to a restricted formulary: the impact of Medicaid preferred drug lists in Illinois and Louisiana. Am J Manag Care 2005; 11: SP14-20
36. Kotzan JA, Perri M III, Martin BC. Assessment of Medicaid prior-approval policies on prescription expenditures: market-share analysis of Medicaid and cash prescriptions. J Manag Care Pharm 1996; 2: 651-6
37. Lexchin J. Effects of restrictive formularies in the ambulatory care setting. Am J Manag Care 2001; 8: 69-76
38. Huskamp HA. Pharmaceutical cost management and access to psychotropic drugs: the US context. Int J Law Psychiatry 2005; 28: 484-95
39. White AC Jr, Atmar RL, Wilson J, et al. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997; 25: 230-9
40. Feldman SR, Fleischer AB, Chen GJ. Is prior authorization of topical tretinoin for acne cost effective? Am J Manag Care 1999; 5: 457-63
41. Fischer MA, Cheng H, Schneeweiss S, et al. Prior authorization policies for selective cyclooxygenase-2 inhibitors in Medicaid (a policy review). Med Care 2006; 44: 658-63