Economic evaluation of a prior authorization program for biologic response modifiers

Drug Benefit Trends

Volumn 20, Issue 1, 2008, Pages 26-31

  Sun, Shawn X ^a   Jing, Yonghua ^b   Aruru, Meghana ^c   Lee, Kwan Y ^d  

^a Walgreens Health Services   (Spain)

^b UNIVERSITY OF CINCINNATI   (United States)

^c UNIVERSITY OF ILLINOIS AT CHICAGO   (United States)

^d Walgreens Health Services

Author keywords

Biologic response modifiers; Prior authorization; Specialty pharmacy

Indexed keywords

ABATACEPT; ADALIMUMAB; ALEFACEPT; EFALIZUMAB; ETANERCEPT; INFLIXIMAB; RECOMBINANT INTERLEUKIN 1 RECEPTOR BLOCKING AGENT;

ADULT; AGED; ANKYLOSING SPONDYLITIS; ARTICLE; COST BENEFIT ANALYSIS; CROHN DISEASE; DRUG APPROVAL; DRUG COST; DRUG UTILIZATION; FEMALE; HEALTH PROGRAM; HUMAN; MALE; OUTCOME ASSESSMENT; PRESCRIPTION; PSORIASIS; PSORIATIC ARTHRITIS; RHEUMATOID ARTHRITIS; SPONDYLOARTHROPATHY;

EID: 38949132113     PISSN: 10805826     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (28)

1. Dong X, Fetterolf D. Specialty pharmacy: an emerging area of interest for medical management. Dis Manag. 2005;8:73-85.
2. Mullins CD, DeVries AR, Hsu VD, et al. Variability and growth in spending for outpatient specialty pharmaceuticals. Health Aff. 2005;24:1117-1127.
3. Fontanez C, McDermott R, Whitehead D. 2004 Specialty Pharmacy Management Guide & Trend Report. Orlando, Fla: CuraScript Pharmacy; June 2005. Available at: www.curascript.com/bin_web/documents/SRxTrendReport04.pdf. Accessed December 17, 2007.
4. Hesselgrave BL. Helping to manage the high cost of rare diseases. Manag Care Q. 2003;11:1-6.
5. National Institute for Health Care Management Foundation. Prescription drug expenditures in 2001: another year of escalating costs. Published May 6, 2002. Available at: www.nihcm.org/~nihcmor/pdf/spending2001.pdf. Accessed December 17, 2007.
6. Arthritis Foundation. Disease index. Available at: www.arthritis.org/ disease-center.php?disease_id=31. Accessed December 17, 2007.
7. National Psoriasis Foundation. About psoriasis. Available at: www.psoriasis.org/about/stats/. Accessed December 17, 2007.
8. Asthma and Allergy Foundation of America. Available at: www.aafa.org/display.cfm?id-8&sub=42. Accessed December 17, 2007.
9. Zitter M. Defining the great debate. Am J Manag Care. 2004;10(8 suppl):S231-S239.
10. Goldman DP, Joyce GF, Lawless G, et al. Benefit design and specialty drug use. Health Aff. 2006;25:1319-1331.
11. About.com. Biologic response modifier: what is it? Available at: http://arthritis.about. com/cs/enbrel/a/biologics.htm. Accessed December 17, 2007.
12. Lubeck DP. A review of the direct costs of rheumatoid arthritis: managed care versus fee-for-service settings. Pharmacoeconomics. 2001;19:811-818.
13. Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics. 2004;22(2 suppl 1):1-12.
14. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Rheumatoid arthritis. Available at: www.niams.nih.gov/Health_ Info/Rheumatic_Disease/default.asp. Published May 2004. Accessed December 17, 2007.
15. Allaire SH, Prashker MJ, Meenan RF. The costs of rheumatoid arthritis. Pharmacoeconomics. 1994;6:513-522.
16. Cooper NJ. Economic burden of rheumatoid arthritis: a systematic review. Rheumatology. 2000;39:28-33.
17. Pugner KM, Scott DI, Holmes JW, Hieke K. The costs of rheumatoid arthritis: an international long-term view. Semin Arthritis Rheum. 2000;29:305-320.
18. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46:328-346.
19. Soumerai SB, Ross-Degnan D, Avorn J, et al. Effects of Medicaid drug-payment limits on admission to hospitals and nursing homes. N Engl J Med. 1991;325:1072-1077.
20. Mackinnon NJ, Kumar R. Prior authorization programs: a critical review of the literature. J Managed Care Pharm. 2001;7:297-302.
21. 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.
22. Kotzan JA, McMillan JA, Jankel CA, Foster AL. Initial impact of a Medicaid prior authorization program for NSAID prescriptions. J Res Pharm Econ. 1993;5:25-41.
23. 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;332:1612-1617.
24. Kotzan JA, Perri M, Martin BC. Assessment of Medicaid prior-approval policies on prescription expenditures: market-share analysis of Medicaid and cash prescriptions. J Manag Care Pharm. 1996;2:651-656.
25. White AC, Atmar RL, Wilson J, et al. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis. 1997;25:230-239.
26. Feldman SR, Fleischer AB, Chen GJ. Is prior authorization of topical tretinoin for acne cost effective? Am J Manag Care. 1999;5:457-463.
27. Mullins CD, Lavallee DC, Pradel FG, et al. Health plans' strategies for managing outpatient specialty pharmaceuticals. Health Aff. 2006;25:1332-1339.
28. Chow C, Gilderman A. Traditional managed care strategies can impact specialty pharmacy programs. Manag Healthcare Executive. Published July 1, 2004. Available at: www.managedhealthcareexecutive.com. Accessed December 17, 2007.