Prior authorization - mandatory advance approval for the use of expensive medications - is now the primary method by which Medicaid programs control expenditures for drugs.
However, whether this policy reduces expenditures for specific drugs without causing the unwanted substitution of other drugs or medical services has been largely unstudied.
We evaluated the effects of a prior-authorization policy involving nongeneric nonsteroidal antiinflammatory drugs (NSAIDs) in the Medicaid program in Tennessee.
We compared monthly Medicaid expenditures that were potentially affected by the policy change during the year before and the two years after its implementation.
We studied prescriptions for NSAIDs, other analgesic or antiinflammatory drugs, and psychotropic drugs, as well as outpatient services and inpatient admissions for the management of pain or inflammation.
At the midpoint of the base-line year, 495,821 people were enrolled in Medicaid.
There was no concomitant increase in Medicaid expenditures for other medical care.
Regular users of nongeneric NSAIDs, those most affected by the policy change, had similar reductions in NSAID expenditures and use, with no increase in expenditures for other medical care.
Prior-authorization requirements may be highly cost effective with regard to expenditures for NSAIDs, drugs that have very similar efficacy and safety but substantial variation in cost.
(N Engl J Med 1995 ; 332 : 1612-7.).
Mots-clés Pascal : Influence, Accord, Assurance maladie, Prescription, Antiinflammatoire non stéroïde, Cher, Région Centre, France, Europe, Résultat, Homme, Etats Unis, Amérique du Nord, Amérique
Mots-clés Pascal anglais : Influence, Agreement, Health insurance, Prescription, Non steroidal antiinflammatory agent, Cher, Centre Region, France, Europe, Result, Human, United States, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0381666
Code Inist : 002B02L. Création : 01/03/1996.