Magazine article Drug Topics

Prior Authorization of Atypicals Cuts All Antipsychotic Use

Magazine article Drug Topics

Prior Authorization of Atypicals Cuts All Antipsychotic Use

Article excerpt

Requiring prior authorization may have a broader impact than expected, A recent study found that prior authorization and other restrictions limiting the use of atypical antipsychotics led to a reduction in the use of all antipsychotic agents in state Medicaid programs.

"If the reduction in the use of atypicals leads through decline in overall antipsychotic use to more poorly controlled schizophrenia in already vulnerable populations, this potentially could have quite severe cost implications," said senior author Dana Goldman, MD, professor of medicine and public policy at the University of Southern California, Los Angeles,

"However, if most of the reductions in antipsychotic use were shown to be reductions in inappropriate use, then using prior authorization could produce benefits to patients in addition to cost savings for Medicaid," Goldman said,

Medicaid claims reviewed

The article, "Medicaid cost control measures aimed at second-generation antipsychotics led to less use of all antipsychotics," was published in the December 2011 issue of Health Affairs, The study was funded by the National Institutes of Health and Janssen Pharmaceuticals,

Researchers reviewed Medicaid policy and fee-for-service claims for antipsychotic, antidepressant, and anticonvulsant agents between 1999 and 2008, They found that prior authorization and other restrictions on atypical agents resulted in a 3,1% decline in the use of all antipsychotic agents. Restricting use of the 2 most often-prescribed atypicals reduced total antipsychotic use by 5,9%, It is not dear why restricting the use of atypicals reduces the use of all antipsychotics, including conventional agents.

Antipsychotics have traditionally been exempted from Medicaid utilization restrictions, but attitudes are changing. One reason is that psychotherapeutic drugs account for one-quarter of all Medicaid drug spending,

"Fiscal pressures have caused a reexamination of this position in many states due to atypical antipsychotic expense increasing significantly since 2000," said Jerry McKee, PharmD, MS, BCPP, associate director of behavioral health pharmacy programs, Community Care of North Carolina, Raleigh, N.C, "This study demonstrates that psychiatric and neurologic medications are no longer viewed as 'untouchable' from the perspective of state Medicaid agencies,"

Researchers compared prescribing restrictions and spending in 30 state Medicaid programs. …

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