Cost and Utilization of Behavioral Health Medications Associated with Rescission of an Exemption for Prior Authorization for Severe and Persistent Mental Illness in the Vermont Medicaid Program

The Effects of Prior Authorization Policies on Medicaid-Enrolled Children's Use of Antipsychotic Medications: Evidence from Two Mid-Atlantic States

“…Unfortunately, we did not have access to diagnostic information, making us unable to determine to what extent utilization of antipsychotic medications varied by child clinical status. Similar to other studies of the impact of prior authorization policies in adults (Cunningham 2005;Soumerai et al 2008;Adams et al 2009;Abouzaid et al 2010;Simeone et al 2010;Walthour et al 2010;Vogt et al 2011), we do not have any way to determine the burden on physicians of the prior authorization policies. Physician burden would be important to measure in future studies, as it might explain the variability in prior authorization policy impacts observed in different studies and/or different states.…”

“…Among 0-5-year-olds there was no significant impact of the antipsychotic prior authorization policy, with the rate of antipsychotic medication use increasing after the prior authorization policy by 0.32%, only slightly less than the 0.36% increase in the use of antidepressants in 0-5-year-olds in the state in the same time frame. Although no comparable data from studies of Medicaid-enrolled children are available, effects of comparable magnitude have been observed in similar studies of adults (Simeone et al 2010;Vogt et al 2011). Several factors could contribute to this modest policy effect.…”

“…A number of studies have raised concerns about prior authorization policies in Medicaid populations, such as the greater treatment discontinuities observed among adults subject to a prior authorization policy for antipsychotic medications (Soumerai et al 2008). Other studies, however, have not found any such negative effects of prior authorization policies reducing the use of antipsychotics (Cunningham 2005;Soumerai et al 2008;Adams et al 2009;Abouzaid et al 2010;Simeone et al 2010;Walthour et al 2010;Vogt et al 2011). With respect to children, little is known about the impact of prior authorization policies on antipsychotic medication use, despite increasing state attention to Medicaid-enrolled child use of antipsychotic medications, highlighted by the establishment of a Medicaid Medical Directors' Learning Network to address use of antipsychotics among children (Foti, 2010), and two subsequent, multi-state, quality collaboratives developed to support states' efforts to improve psychotropic prescribing practices.…”

Public-Academic Partnerships: A Program to Improve the Quality of Antipsychotic Prescribing in a Community Mental Health System

“…These programs require clinicians to use medications considered preferred before using other medications within the same class, thereby shaping prescribing practices toward use of less expensive, but therapeutically similar or equivalent, agents. These programs are designed to contain costs while maintaining access to many or all medications (7)…”

Pharmaceutical Step-Therapy Interventions: A Critical Review of the Literature

“…22 Furthermore, in the Vermont Medicaid program, rescission of a PA exemption for new users of antipsychotics, antidepressants, and anxiolytics/sedatives was not followed by decreased utilization of medications on the PA list, and mental health-related hospitalizations declined following removal of the PA exemption. 32 As none of the studies that found increased treatment discontinuities examined other medical utilization or clinical outcomes, it is unclear whether the potentially inconsistent findings are due to differences in program design or a lack of short-term link between decreased medication use and use of other medical services. If the latter, are the observed treatment discontinuities leading to negative effects on important clinical outcomes that do not necessarily manifest in claims-based measures of utilization?…”