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Comparative Study
. 2009 Apr 27;169(8):750-6.
doi: 10.1001/archinternmed.2009.39.

Prior authorization for antidepressants in Medicaid: effects among disabled dual enrollees

Alyce S Adams  1 , Fang Zhang, Robert F LeCates, Amy Johnson Graves, Dennis Ross-Degnan, Daniel Gilden, Thomas J McLaughlin, Christine Lu, Connie M Trinacty, Stephen B Soumerai
Affiliations
Comparative Study

Prior authorization for antidepressants in Medicaid: effects among disabled dual enrollees

Alyce S Adams et al. Arch Intern Med. .

Abstract

Background: Prior authorization is a popular, but understudied, strategy for reducing medication costs. We evaluated the impact of a controversial prior authorization policy in Michigan Medicaid on antidepressant use and health outcomes among dual Medicaid and Medicare enrollees with a Social Security Disability Insurance designation of permanent disability.

Methods: We linked Medicaid and Medicare (2000-2003) claims for dual enrollees in Michigan and a comparison state, Indiana. Using interrupted time-series and longitudinal data analysis, we estimated the impact of the policy on antidepressant medication use, treatment initiation, disruptions in therapy, and adverse health events among continuously enrolled (Michigan, n = 28 798; Indiana, n = 21 769) and newly treated (Michigan, n = 3671; Indiana, n = 2400) patients.

Results: In Michigan, the proportion of patients starting nonpreferred agents declined from 53% prepolicy to 20% postpolicy. The prior authorization policy was associated with a small sustained decrease in therapy initiation overall (9 per 10,000 population; P = .007). We also observed a short-term increase in switching among established users of nonpreferred agents overall (risk ratio, 2.88; 95% confidence interval, 1.87-4.42) and among those with depression (2.04; 1.22-3.42). However, we found no evidence of increased disruptions in treatment or adverse events (ie, hospitalization, emergency department use) among newly treated patients.

Conclusions: Prior authorization was associated with increased use of preferred agents with no evidence of disruptions in therapy or adverse health events among new users. However, unintended effects on treatment initiation and switching among patients already taking the drug were also observed, lending support to the state's previous decision to discontinue prior approval for antidepressants in 2003.

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Figures

Fig 1
Fig 1
Monthly Prevalence of Antidepressant Use by Type of Drug in Each State
Fig 2
Fig 2
Rates of Antidepressant Therapy Initiation (MI: 28,798, IN: 21,769) and Switching among Established SSRI/SNRI Users (MI: 14,638, IN: 10,398)
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Comment in

  • The change we need in health care.
    Goff DC Jr, Greenland P. Goff DC Jr, et al. Arch Intern Med. 2009 Apr 27;169(8):737-9. doi: 10.1001/archinternmed.2009.24. Arch Intern Med. 2009. PMID: 19398683 No abstract available.

References

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