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Impact of a Pregabalin Step Therapy Policy Among Medicare Advantage Beneficiaries
Author(s) -
Suehs Brandon T.,
Louder Anthony,
Udall Margarita,
Cappelleri Joseph C.,
Joshi Ashish V.,
Patel Nick C.
Publication year - 2014
Publication title -
pain practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 58
eISSN - 1533-2500
pISSN - 1530-7085
DOI - 10.1111/papr.12073
Subject(s) - medicine , pregabalin , cohort , pharmacy , prior authorization , formulary , medicare advantage , managed care , gabapentin , health care , medicare part d , fibromyalgia , medical prescription , family medicine , physical therapy , prescription drug , psychiatry , alternative medicine , nursing , pathology , economics , economic growth
Background Managed healthcare organizations often utilize formulary management strategies such as prior authorization and step therapy to guide appropriate medication use and to control medication expenditures. The objective of this study was to examine clinical and economic outcomes associated with implementation of a pregabalin step therapy ( ST ) policy among Medicare Advantage Prescription Drug ( MAPD ) members. Methods Pharmacy and medical claims data from Humana (restricted cohort; ST policy implemented 01/01/2009) and Thomson Reuters MarketScan ® (unrestricted cohort) were analyzed for MAPD members aged 65 to 89 years receiving treatment for painful diabetic peripheral neuropathy ( pDPN ), postherpetic neuralgia (PHN) or fibromyalgia (FM). Difference‐in‐differences (DID) was used to examine year‐over‐year changes in disease‐related and all‐cause utilization and costs. Regression analyses examined medication utilization and healthcare expenditures after controlling for between‐group compositional differences. Results We identified 13,911 members in the restricted cohort and matched to members from unrestricted health plans. FM (51.0%) and pDPN (41.8%) were the most common diagnoses. Members in the unrestricted cohort were older and had a greater level of comorbidity than members in the restricted cohort. The restricted cohort demonstrated greater year‐over‐year decrease in pregabalin utilization and increase in year‐over‐year gabapentin utilization compared with the unrestricted cohort. ST restriction was associated with an increase in disease‐related pharmacy costs and a decrease in total medical costs for the restricted cohort compared with the unrestricted cohort. There was no difference between cohorts in total healthcare cost. Conclusion After controlling for differences in age and comorbidity burden between the groups, implementation of a pregabalin ST restriction was associated with increased disease‐related pharmacy costs and decreased total medical costs; however, there was no net difference in total healthcare cost or total pharmacy cost.