Impact of Medicaid Prior Authorization Requirement for COX‐2 Inhibitor Drugs in Nebraska

BackgroundNew drugs often substitute others cheaper and with a risk-benefit balance better established. Our aim was to analyse the diffusion of new drugs during the first months of use, examining the differences between family physicians and specialists.MethodsPrescription data were obtained of cefditoren, duloxetine, etoricoxib, ezetimibe, levocetirizine, olmesartan, pregabalin and tiotropium 36 months after their launching. We obtained the monthly number of prescriptions per doctor and the number prescribers of each drug by specialty.After discarding those with less than 10 prescriptions during this period, physicians were defined as adopters if the number of prescriptions was over the 25th percentile for each drug and level (primary or secondary care). The diffusion of each drug was studied by determining the number of adopter family physicians throughout the study period. Among the group of adopters, we compared the month of the first prescription by family physicians to that of other specialists using the Kaplan-Meier method.ResultsThe adoption of the drugs in primary care follows an exponential diffusion curve that reaches a plateau at month 6 to 23. Tiotropium was the most rapidly and widely adopted drug. Cefditoren spread at a slower rate and was the least adopted. The diffusion of etoricoxib was initially slowed down due to administrative requirements for its prescription. The median time of adoption in the case of family physicians was 4-6 months. For each of the drugs, physicians of a specialty other than family physicians adopted it first.ConclusionsThe number of adopters of a new drug increases quickly in the first months and reaches a plateau. The number of adopter family physicians varies considerably for different drugs. The adoption of new drugs is faster in specialists. The time of adoption should be considered to promote rational prescribing by providing timely information about new drugs and independent medical education.

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“…The effect of an authorization requirement for COX-2 inhibitor drugs has been determined in the U.S.A [18]. …”

Section: Discussionmentioning

confidence: 99%

Adoption of new drugs by physicians: a survival analysis

Garjón

Azparren

Vergara

et al. 2012

BMC Health Serv Res

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“…Provisions of resources to both physicians and pharmacists in the form of reference cards, computerized order entry with decision support, and modification of formularies have been more successful in changing prescription behavior . Alteration of insurance reimbursement models also has the potential to impact prescription practices . Such strategies are all possible avenues through which to reduce codeine prescription to children and adolescents.…”

Section: Discussionmentioning

confidence: 99%

Codeine use among children in the United States: a nationally representative study from 1996 to 2013

Livingstone

Groenewald

Rabbitts

et al. 2016

Pediatric Anesthesia

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Background Concerns regarding the safety of codeine have been raised. Cases of life-threatening respiratory depression and death in children have been attributed to codeine’s polymorphic metabolic pathway. International health agencies recommend restricted use of codeine in children. Despite these recommendations, the epidemiology of codeine use among children remains unknown. Aims Our objective was to examine patterns of codeine use in the US among children. Methods A cross-sectional analysis of children ages 0–17 years from 1996–2013 in the US was performed. Data was extracted from MEPS, a nationally representative set of health care surveys. Prevalence rates of codeine use between 1996 and 2013 were examined. Multivariable logistic regression examined relationships between codeine use and patient demographics. Results Codeine use remained largely unchanged from 1996 to 2013 (1.08 vs. 1.03 million children, respectively). Odds of codeine use was higher in ages 12–17 (OR, 1.40; [1.21–1.61]), outside of the Northeast US, and among those with poor physical heath status (OR, 3.29 [1.79–6.03]). Codeine use was lower in children whose ethnicity was not white and those uninsured (OR, 0.47 [0.34–0.63]). Codeine was most frequently prescribed by emergency physicians (18%) and dentists (14%). The most common condition associated with codeine use was trauma-related pain. Conclusions Pediatric codeine use has declined since 1996, however more than 1 million children still used codeine in 2013. Health care providers must be made aware of guidelines advising against the use of codeine in children. Codeine is potentially hazardous and safer alternatives to treat children’s pain are available.

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“…Implementing specific strategies may assist future costs and volumes of prescriptions [15, [69][70][71][72][73]. Gleason et al, in a study evaluating the effects of a COX-2 inhibitor prior authorization programme,have shown that the plan implementation assisted in cost containment [74]. Similarly, Siracuse et al, in a study to explore the impact of the prior authorization programme on Medicaid pharmacy expenditures and utilization of NSAIDs and COX-2 inhibitors, showed that the overall expenditures on COX-2 inhibitors for Nebraska Medicaid dropped by 50% [75].Also,the study showed that the overall pharmacy expenditures for those patients who switched from a COX-2 inhibitor to an NSAID or other pain reliever declined by approximately 35% [75].…”

Section: Discussionmentioning

confidence: 99%

Comparison of nonsteroidal anti‐inflammatory drugs and cyclooxygenase‐2 (COX‐2) inhibitors use in Australia and Nova Scotia (Canada)

Barozzi

Sketris

Cooke

et al. 2009

Brit J Clinical Pharma

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WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Cyclo‐oxygenase‐2 (COX‐2) inhibitors were marketed aggressively and their rapid uptake caused safety concerns and budgetary challenges in Canada and Australia. WHAT THIS STUDY ADDS • The study showed that there were similarities in the anti‐inflammatory prescribing pattern between Australia and Nova Scotia; however, volumes of both ns‐NSAIDs and COX‐2 inhibitors prescribed were higher in Australia in the study period. The remarkable increase observed in Australia in NSAIDs use was essentially due to the much higher COX‐2 inhibitor use. Differences in regulatory and marketing practices, as well as cultural and historical differences might be some of the reasons for differences in the NSAID prescribing between Australia and Nova Scotia. AIMS Cyclooxygenase‐2 (COX‐2) inhibitors were marketed aggressively and their rapid uptake caused safety concerns and budgetary challenges in Canada and Australia. The objectives of this study were to compare and contrast COX‐2 inhibitors and nonselective nonsteroidal anti‐inflammatory drug (ns‐NSAID) use in Nova Scotia (Canada) and Australia and to identify lessons learned from the two jurisdictions. METHODS Ns‐NSAID and COX‐2 inhibitor Australian prescription data (concession beneficiaries) were downloaded from the Medicare Australia website (2001–2006). Similar Pharmacare data were obtained for Nova Scotia (seniors and those receiving Community services). Defined daily doses per 1000 beneficiaries day−1 were calculated. COX‐2 inhibitors/all NSAIDs ratios were calculated for Australia and Nova Scotia. Ns‐NSAIDs were divided into low, moderate and high risk for gastrointestinal side‐effects and the proportions of use in each group were determined. Which drugs accounted for 90% of use was also calculated. RESULTS Overall NSAID use was different in Australia and Nova Scotia. However, ns‐NSAID use was similar. COX‐2 inhibitor dispensing was higher in Australia. The percentage of COX‐2 inhibitor prescriptions over the total NSAID use was different in the two countries. High‐risk NSAID use was much higher in Australia. Low‐risk NSAID prescribing increased in Nova Scotia over time. The low‐risk/high‐risk ratio was constant throughout over the period in Australia and increased in Nova Scotia. CONCLUSIONS There are significant differences in Australia and Nova Scotia in use of NSAIDs, mainly due to COX‐2 prescribing. Nova Scotia has a higher proportion of low‐risk NSAID use. Interventions to provide physicians with information on relative benefits and risks of prescribing specific NSAIDs are needed, including determining their impact.

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Impact of Medicaid Prior Authorization Requirement for COX‐2 Inhibitor Drugs in Nebraska

Cited by 22 publications

References 16 publications

Adoption of new drugs by physicians: a survival analysis

Adoption of new drugs by physicians: a survival analysis

Codeine use among children in the United States: a nationally representative study from 1996 to 2013

Comparison of nonsteroidal anti‐inflammatory drugs and cyclooxygenase‐2 (COX‐2) inhibitors use in Australia and Nova Scotia (Canada)

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