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Prior Authorization in the Treatment of Patients with pDPN and FM
Author(s) -
Placzek Hilary E. D.,
Masters Elizabeth T.,
Gu Tao,
Cappelleri Joseph C.,
Wasser Thomas E.,
Clair Andrew G.,
Cook Joseph P.,
Eisenberg Debra F.
Publication year - 2015
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.12258
Subject(s) - medicine , cohort , retrospective cohort study , pharmacy , authorization , prior authorization , cohort study , medical record , propensity score matching , fibromyalgia , family medicine , pharmacology , computer security , computer science
Purpose To determine prior authorization (PA) impact on healthcare utilization, costs, and pharmacologic treatment patterns for painful diabetic peripheral neuropathy ( pDPN ) and fibromyalgia (FM). Methods This retrospective, observational, longitudinal cohort study used medical and pharmacy claims data. Newly diagnosed patients treated for FM or pDPN between 7/1/2007 and 12/31/2011 were included. PA and no PA groups were matched by propensity score 4:1. Medical resource utilization, direct medical and pharmacy costs, and treatment pattern differences were compared. Pre and postindex differences between PA and no PA cohorts were determined by difference in difference analysis. Results Analysis of 2,315 FM patients (1,852 PA; 463 no PA) demonstrated greater increases in postindex all‐cause costs ($197; P = 0.6673) and disease‐related costs ($72; P = 0.4186) in the PA cohort. Analysis of 1,300 pDPN patients (1,040 PA; 260 no PA) demonstrated postindex all‐cause cost increases of $1,155 more in the no PA cohort ( P = 0.6248); disease‐related costs decreased $2,809 more in the no PA cohort ( P = 0.4312). Treatment patterns were similar between cohorts; opioid usage was higher in the FM PA cohort ( P = 0.0082). Conclusions There was no evidence of statistically significant differences between PA and no PA cohorts in either FM or pDPN populations for total all‐cause or disease‐related costs.