Impact of a Pregabalin Step Therapy Policy Among Medicare Advantage Beneficiaries

Abstract

After controlling for differences in age and comorbidity burden between the groups, implementation of a pregabalin ST restriction was associated with increased disease-related pharmacy costs and decreased total medical costs; however, there was no net difference in total healthcare cost or total pharmacy cost.

Prior Authorization in the Treatment of Patients with pDPN and FM

“…The results of the present research are broadly consistent with those of Udall et al. and Suehs et al., who had similar findings in that the studied formulary restrictions for these disease areas were not associated with a statistically significant decrease in costs . Moreover, costs associated with PA administrative fees were not included in this analysis.…”

“…In the FM population, opioid use was significantly higher in the PA cohort, while this difference was not seen in the pDPN population. The shifting of patients to alternate pharmacologic therapy choices was also evidenced in research by Suehs et al., in which there was a statistically significant increase in the use of gabapentin and a nonsignificant increase in the use of opioids with no significant decrease in disease‐related pharmacy expenditures following the implementation of restricting step therapy policy . Currently, there is not a good evidence base to support the use of NSAIDs in managing neuropathic pain.…”

“…The results of the present research are broadly consistent with those of Udall et al and Suehs et al, who had similar findings in that the studied formulary restrictions for these disease areas were not associated with a statistically significant decrease in costs. 23,24 Moreover, costs associated with PA administrative fees were not included in this analysis. It is possible that costs among patients in the PA cohort could be higher than those in the no PA cohort if these administrative costs had been included in the analysis.…”

“…The shifting of patients to alternate pharmacologic therapy choices was also evidenced in research by Suehs et al, in which there was a statistically significant increase in the use of gabapentin and a nonsignificant increase in the use of opioids with no significant decrease in disease-related pharmacy expenditures following the implementation of restricting step therapy policy. 24 Currently, there is not a good evidence base to support the use of NSAIDs in managing neuropathic pain. A few small trials of short duration and/or mild to moderate neuropathic pain severity, while showing some benefit, are not substantiated because an evidence base does not exist.…”

Why We Should Not Be Indifferent to Specification Choices for Difference‐in‐Differences

“…; Suehs et al. ), smoking laws (Anger, Kvasnicka, and Siedler ; Nguyen ), electronic medical record implementation (Jones et al. ; McCullough, Christianson, and Leerapan ), and conflict of interest policies (Epstein et al.…”