Prior authorization for topical psoriasis treatments: Is it cost-beneficial for managed care?

Journal of Dermatological Treatment

Volumn 21, Issue 3, 2010, Pages 178-184

  Balkrishnan, Rajesh ^a,b   Bhosle, Monali J ^c   Fleischer Jr , Alan B ^b   Feldman, Steven R ^b  

^a UNIVERSITY OF MICHIGAN   (United States)

^b WAKE FOREST SCHOOL OF MEDICINE   (United States)

^c IMS Healthcare   (United States)

Author keywords

Calcipotriene; Dermatology; Managed care; Psoriasis; Tazarotene

Indexed keywords

CALCIPOTRIOL; CALCITRIOL; RETINOIC ACID; TAZAROTENE;

COST BENEFIT ANALYSIS; COST OF ILLNESS; HEALTH CARE SYSTEM; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; HUMAN; MANAGED CARE ORGANIZATION; PRIORITY JOURNAL; PSORIASIS; REVIEW;

ADMINISTRATION, TOPICAL; COST SAVINGS; COST-BENEFIT ANALYSIS; DERMATOLOGIC AGENTS; DRUG COSTS; DRUG PRESCRIPTIONS; FEMALE; HEALTH CARE COSTS; HEALTH CARE SURVEYS; HUMANS; MALE; MANAGED CARE PROGRAMS; MODELS, ECONOMIC; PSORIASIS; UNITED STATES;

EID: 77951128428     PISSN: 09546634     EISSN: 14711753     Source Type: Journal    
DOI: 10.3109/09546630903268247     Document Type: Review

References (49)

1. Estimates from Centers for Medicare and Medicaid Services. 2005 www.cms.gov, Last accessed September 2009.
2. The Henry J. Kaiser Family Foundation. The uninsured: A primer, key facts about Americans without health insurance. Menlo Park, CA: KFF [2004; cited 2005 June 20]. Available from: http://www.kff.org/uninsured/upload/7216.pdf
3. Valley Baptist Health Plans. 4-Tier prescription benefit. Harlingen, TX: Valley Baptist Health Plans [March 2004; cited 2005 June 7]. Available from: http://www.valleyhealthplans. com/Valley%20Baptist%204%20Tier%20Drug%20List% 200304.pdf
4. Presbyterian Health Plan. 4-Tier prescription drug program. Albuquerque, NM: Presbyterian [cited 2005 June 7]. Available from: http://www.phs.org/ resources/documents/4tierfaq.pdf
5. Kreling D, Mucha R. Drug product management in maintenance organizations. Am J Hosp Pharm. 1992;49:374-381.
6. Wisconsin Medicaid [cited 2005 June 7]. Available from: http://dhfs.wisconsin.gov/medicaid2/handbooks/all-provider/ pa/general-1.htm. Montvale, NJ.; 2005.
7. Cigna. Pharmacy prior authorization request forms. Greenock, Inverclyde: CIGNA HealthCare [cited 2005 June 7]. Available from: http://www.cigna.com/ health/consumer/service/ pharmacy-priorauth.html
8. Wyoming Medicaid. Prior Authorization Program. Provider training manual. Cheyenne, WY: Wyoming Medicaid [June 2003; cited 2005 June 7]. Available from: http:// wyequalitycare.acs-inc.com/forms/WyTrainingManual070103. pdf
9. MacKinnon NJ, Kumar R. Prior authorization programs: A critical review of the literature. J Manag Care Pharm. 2001;7:297-302.
10. 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.
11. Smalley WE, Griffin MR, Fought RL, Sullivan L, Ray WA. Effect of a prior-authorization requirement on the use of nonsteroidal antiinflammatory drugs by Medicaid patients. N Engl J Med. 1995;332:1612-1617.
12. 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.
13. White AC Jr, Atmar RL, Wilson J, Cate TR, Stager CE, Greenberg SB. Effects of requiring prior authorization for selected antimicrobials: Expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis. 1997;25:230-239. (Pubitemid 127775484)
14. The Wyeth-Ayerst prescription drug benefit cost and plan design survey report. Philadelphia, PA: Wyeth-Ayerst Laboratories; 1999. p. 11.
15. Reissman D. What is the real cost of prior authorization? Drug Benefit Trends. 2000;12:22, 24.
16. Herrier RN, Spencer JR, Davis CD. Case study using descriptive analysis to estimate hidden costs in processing third party prescriptions. J Am Pharm Assoc. 2000;40: 658-665.
17. Feldman SR, Fleischer AB, Chen GJ. Is prior authorization of topical tretinoin for acne cost effective? Am J Manag Care. 1999;5:457-463.
18. Carter CA, Brookfield RB. Consequences of prior authorization programs - A case example: DDAVP in pediatric nocturnal enuresis. Am J Manag Care. 1996;2:715-718.
19. Montana Department of Health and Human Services. Prior authorization. [cited 2005 June 7]. Available from: http://www.dphhs.mt.gov/hpsd/medicaid/ medicaid2/pdf/ pharmacyreplacement1104.pdf
20. North Dakota Department of Health and Human Services. Testimony before the House Human Services Committee. Clara Sue Price, Chairman. HB 1465 - medical assistance management. Bismarck, ND: DHS [2005 January 31; cited 2005 June 7]. Available from: http://www.state.nd.us/ humanservices/info/testimony/house- human-services/hb1465- 2005-01-31.html
21. Galderma quality report for dermatology & managed care. Fort Worth, TX: Galderma Laboratories; 2005.
22. Peck P. Biologics for psoriasis have wide variation in price, ease of use. Medscape Conference Coverage of American Academy of Dermatology, 63rd Annual Meeting: Poster 2. Presented by Abramovits W; 2005 Feb 19.
23. Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41: 401-407.
24. Javitz HS, Ward MM, Farber E, Nail L, Vallow SG. The direct cost of care for psoriasis and psoriatic arthritis in the United States. J Am Acad Dermatol. 2002;46: 850-860.
25. Feldman SR, Fleischer AB Jr, Reboussin DM, Rapp SR, Bradham DD, Exum ML, et al. The economic impact of psoriasis increases with psoriasis severity. J Am Acad Dermatol. 1997;37:564-569.
26. Choi J, Koo JYM. Quality of life issues in psoriasis. J Am Acad Dermatol. 2003;49(suppl):S57-S61.
27. National Guideline Clearinghouse (NGC). Snellman E. Psoriasis. In: EBM Guidelines. Evidence-based medicine [CD-ROM]. Helsinki, Finland: Duodecim Medical Publications Ltd [2004; cited 2005 June 6]. Available from: http:// www.guidelines.gov/summary/summary.aspx?doc-id=5670& mode=full&ss=15
28. Dubertret L, Wallach D, Souteyrand P, Perussel M, Kalis B, Meynadier J, et al. Efficacy and safety of calcipotriol (MC 903) ointment in psoriasis vulgaris. A randomized, double-blind, right/left comparative, vehicle-controlled study. J Am Acad Dermatol. 1992; 27(6 pt 1):983-988.
29. Kragballe K, Gjertsen BT, De Hoop D, Karlsmark T, van de Kerkhof PC, Larkö O, et al. Double-blind, right/left comparison of calcipotriol and betamethasone valerate in treatment of psoriasis vulgaris. Lancet. 1991; 337: 193-196.
30. Weinstein GD, Krueger GG, Lowe NJ, Duvic M, Friedman DJ, Jegasothy BV, et al. Tazarotene gel, a new retinoid, for topical therapy of psoriasis: Vehicle-controlled study of safety, efficacy, and duration of therapeutic effect. J Am Acad Dermatol. 1997;37:85-92.
31. Duvic M. Tazarotene: A review of its pharmacological profile and potential for clinical use in psoriasis. Expert Opin Investig Drugs. 1997;6:1537-1551.
32. Green L, Sadoff W. A clinical evaluation of tazarotene 0.1% gel, with and without a high- or mid-high-potency corticosteroid, in patients with stable plaque psoriasis. J Cutan Med Surg. 2002;6:95-102.
33. Dhawan SS, Blyumin ML, Pearce DJ, Feldman SR. Tazarotene cream (0.1%) in combination with betamethasone valerate foam (0.12%) for plaque-type psoriasis. J Drugs Dermatol. 2005; 4:228-230.
34. Ashcroft DM, Li Wan Po A, Williams HC, Griffiths CE. Combination regimens of topical calcipotriene in chronic plaque psoriasis: Systematic review of efficacy and tolerability. Arch Dermatol. 2000;136:1536-1543.
35. Douglas WS, Poulin Y, Decroix J, Ortonne JP, Mrowietz U, Gulliver W, et al. A new calcipotriol/betamethasone formulation with rapid onset of action was superior to monotherapy with betamethasone dipropionate or calcipotriol in psoriasis vulgaris. Acta Derm Venereol. 2002; 82:131-135.
36. Kaufmann R, Bibby AJ, Bissonnette R, Cambazard F, Chu AC, Decroix J, et al. A new calcipotriol/betamethasone dipropionate formulation (Daivobet) is an effective once-daily treatment for psoriasis vulgaris. Dermatology. 2002;205:389-393.
37. Hart-Hansen K, Kjaer T, Norregaard J. The willingness-topay for psoriasis treatment in Denmark [PSN11]. Poster presented at ISPOR 6th Annual European Conference; 2001 May 20-23; Arlington, VA.
38. Sorensen M, Norregaard J. Pharmacoeconomic review of a new two compound ointment (Dovobet-) and calcipotriol (Daivonex-) in the treatment of psoriasis vulgaris in Sweden [abstract PES10]. Value Health. 2002;5:554-555.
39. Norregaard J, Lowson D. The cost utility of calcipotriol/ betamethasone (Dovobet) ointment in the treatment of psoriasis in the United Kingdom [abstract PSN5]. Value Health. 2003;6:785.
40. Guenther L, Van de Kerkhof PC, Snellman E, Kragballe K, Chu AC, Tegner E, et al. Efficacy and safety of a new combination of calcipotriol and betamethasone dipropionate (once or twice daily) compared to calcipotriol (twice daily) in the treatment of psoriasis vulgaris: A randomized, doubleblind, vehicle-controlled clinical trial. Br J Dermatol. 2002;147:316-323.
41. Van de Kerkhof PC. The impact of a two-compound product containing calcipotriol and betamethasone dipropionate (Daivobet/Dovobet) on the quality of life in patients with psoriasis vulgaris: A randomized controlled trial. Br J Dermatol. 2004;151:663-668.
42. Zaghloul SS, Goodfield JJ. Objective assessment of compliance with psoriasis treatment. Arch Dermatol. 2004; 140:408-414.
43. Parslew R, Traulsen J. Efficacy and local safety of a calcipotriol/ betamethasone dipropionate ointment in elderly patients with psoriasis vulgaris. Eur J Dermatol. 2005;15:37-39.
44. Optima Health, Richmond, VA, USA. Preferred and standard drugs. [Summer 2004; cited 2005 June 7]. Available from: http://www.optimahealth.com/NR/ rdonlyres/7953F63EF916- 4993-B767-AE259157438C/1292/prefstnd2004summer. pdf
45. Guenther L, Van de Kerkhof PC, Snellman E, Kragballe K, Chu AC, Tegner E, et al. Per-gram cost of medication is by itself a poor indicator for comparing costs of different psoriasis treatments: A retrospective cohort study of the cost of psoriasis treatment with topical corticosteroids versus topical calcipotriol. J Cutan Med Surg. 2000;4:121-125.
46. Red Book, 2005: Pharmacy's fundamental reference. 109th ed. Montvale, NJ: Medical Economics Co.; 2005.
47. Kulkarni AS, Balkrishnan R, Richmond D, Pearce DJ, Feldman SR. Medication-related factors affecting health care outcomes and costs for patients with psoriasis in the United States. J Am Acad Dermatol. 2005;52:27-31.
48. Balkrishnan R, Sansbury JC, Shenolikar RA, Fleischer AB Jr, Feldman SR. Prescribing patterns for topical retinoids within NAMCS data. J Drugs Dermatol. 2005;4:172-179.
49. Owen JA Jr. Prior authorization made simple. Va Med Q. 1993;120:184-185.