title: HMO direct costs and health care resources use after implementation of a monthly limit on sumatriptan.
abstract: The health care costs and resource use of patients with migraine before and after a quantity limit on sumatriptan was introduced in an HMO were compared. A longitudinal, retrospective review of a medical claims database and a pharmacy claims database was conducted for two six-month periods before and after a monthly limit (four tablets or injections) on sumatriptan reimbursement was instituted at an independent practice association-model HMO in February 1997. Patients with at least one medical claim with a diagnosis code for migraine or at least two pharmacy claims for sumatriptan, methysergide, ergotamine, dihydroergotamine, or an ergotamine combination product in 1996 or 1997 were eligible for inclusion. A total of 557 patients were included in the analysis. Migraine-related medical costs and total medical costs increased 1.5% and 24.4%, respectively; neither change was statistically significant. Physician office visits related to migraine increased by 7.8%. The number of hospital admissions for the cohort increased from three to five, but hospital costs decreased by 55.0%. The overall costs of medications for migraine therapy decreased by 4.5%. There was an 8.2% increase in prescriptions for drugs to treat migraine but a 40.0% decrease in their cost, primarily because of decreased sumatriptan use. There was a 33.9% increase in prescriptions for medications that could be used as prophylaxis for migraine and a 49.6% increase in their cost. Implementation of a monthly limit on sumatriptan decreased an HMO's pharmacy costs but did not significantly alter migraine-related direct medical costs and health care resource use of patients with migraine.
authors.affiliation: Managed Care Pharmacy, Advance Paradigm Clinical Services, Hunt Valley, MD, USA. scott.d.goldfarb@am.pnu.com
authors.forename: S D
authors.initials: SD
authors.lastname: Goldfarb
authors.forename: B S
authors.initials: BS
authors.lastname: Duncan
authors.forename: P E
authors.initials: PE
authors.lastname: Dans
authors.forename: A S
authors.initials: AS
authors.lastname: Sloan
mesh_terms: D016527:Drug Costs; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs; D008881:Migraine Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D018170:Sumatriptan / Q000627:therapeutic use*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D018170:Sumatriptan