Impact of Overactive Bladder Step Therapy Policies on Medication Utilization and Expenditures Among Treated Medicare Members

Abstract

This research was funded by Astellas Pharma Global Development and was conducted as part of the Astellas-Humana Research Collaboration. Ng, Kristy, Schermer, and Bradt are employees of Astellas. Astellas manufactures mirabegron (Myrbetriq) and solifenacin (VESIcare). Abbass, Caplan, Collins, and Suehs are employees of Comprehensive Health Insights, a subsidiary of Humana, which received funding from Astellas for this study. Suehs owns stock in Humana. Chan is an employee of Humana Pharmacy Solutions. Portions of this study were presented as a poster at Academy of Managed Care Pharmacy Nexus 2015; October 26-29, 2015; Orlando, Florida. Study concept and design were contributed by Ng, Chan, Suehs, and Abbass, along with Collins. Abbass took the lead in data collection, along with Collins and with assistance from Caplan, Chan, and Suehs. Data interpretation was provided by Kristy and Bradt, along with Abbass, Caplan, Ng, Suehs, Collins, and Chan. The manuscript was written primarily by Caplan, along with Schermer, Suehs, and Abbass, and revised by Caplan, Schermer, and Ng, along with the other authors.

Overactive bladder medication: Anticholinergics versus mirabegron by specialty

“…One facet is insurance programs often necessitating trial of anticholinergics prior to approval of coverage for mirabegron, or step therapy policies. Abbas et al., 12 compared medication utilization before and after discontinuation of a step therapy policy. In this Humana policy, trial of two other anticholinergics was required prior to the approval of fesoterodine and mirabegron.…”

Differential Prescribing of Antimuscarinic Agents in Older Adults with Cognitive Impairment

“…The initial prescribed antimuscarinic may not be the same as the one dispensed as switching to a less expensive or formulary-preferred medication may have occurred following provider approval. As many other antimuscarinics or mirabegron may not be available to patients due to formulary restrictions and increased co-payment costs, 20 patients may have to choose between oral oxybutynin, which carries the risk of worsening cognition, or no treatment, which may result in sequelae such as falls, depression, or reduced quality of life due to untreated OAB. 43–49 Moreover, mirabegron, a beta-3 agonist which improves OAB symptoms without blocking antimuscarinic receptors, may theoretically be a better option than other antimuscarinics; however, medication formularies and costs may make mirabegron difficult to afford for many patients after other antimuscarinics become generic.…”

“…11–16,19 However, other antimuscarinics and mirabegron may not be readily available to patients due to formulary restrictions and increased co-payment costs which may lead to the use oral oxybutynin in patients with cognitive impairment or the avoidance of treatment in patients with OAB. 20 Understanding the association between cognitive impairment and costs on the differential prescribing of antimuscarinics may lead to a better understanding of prescribing behavior in the use of oral oxybutynin versus other antimuscarinics. The aim of this study was to evaluate factors suggestive of documented cognitive impairment on the prescribing of oral oxybutynin versus other antimuscarinics in a general population of older adults.…”

Clinical preferences and treatment attitudes among urologists, gynecologists, and geriatricians: An independent online questionnaire survey for comparison of treatment choices in the management of overactive bladder

“…It has also been shown that after beta-3 agonists were available in the market, a shift in prescription habits of the physicians has occurred. 13,14 In clinical practice, patients with OAB also present to and are treated by urologists (URO), obstetricians and gynecologists (OB/GYN), and geriatricians (GER). Treatment choices can vary due to several factors and prescription differences may occur between specialties.…”

“…Despite the fact that antimuscarinics are the most commonly prescribed drugs, an increase in prescriptions for mirabegron and other central nervous system sparing molecules has occurred. It has also been shown that after beta‐3 agonists were available in the market, a shift in prescription habits of the physicians has occurred 13,14 …”