title: Effectiveness of risk management plans: a case study of pemoline using pharmacy claims data.
abstract: OBJECTIVE
  To assess the effectiveness of a pharmaceutical risk management plan using pemoline as a case study and pharmacy claims as the data source.
  
  
  METHODS
  Prescription claims from a continuously enrolled US population (September 1, 2000-September 30, 2002) from Caremark, a pharmacy benefit manager, were evaluated for patients with one or more pemoline claims. Patients were categorized using pemoline as second-line or first-line therapy depending on presence or absence of other central nervous system (CNS) stimulants prescriptions 90 days prior to the first pemoline claim. Logistic regression was performed to compare second-line and first-line usage with regard to patient age, gender and prescribing physician specialty and region of practice.
  
  
  RESULTS
  Of 1,279,296 prescription claims for CNS stimulants, 17,256 (1.3%) were for pemoline. Nine hundred thirteen patients received pemoline and had 90 days or more prior enrollment. Overall, 10% of patients receiving pemoline received it as second-line therapy (95%CI: 8-12%). After adjusting for age, gender, specialty, and region, the odds of receiving pemoline as second-line therapy were significantly greater in pediatrics relative to adults (OR = 2.82, 95%CI: 1.58-5.03), and among those whose prescribers were psychiatrists versus primary care physicians (OR = 2.48, 95%CI: 1.37-4.50). Children treated by a psychiatrist had the greatest likelihood for use as second-line therapy (36%, 95%CI: 19-56%).
  
  
  CONCLUSIONS
  Among patients who received pemoline, concordance with second-line therapy recommendations was low, even among the primary target audience of children. These results in a large geographically diverse patient population are consistent with an earlier regional study.
authors.affiliation: University of Colorado at Denver and Health Sciences Center, Denver, CO, USA.
authors.forename: Elaine H
authors.initials: EH
authors.lastname: Morrato
authors.forename: Judy A
authors.initials: JA
authors.lastname: Staffa
mesh_terms: D000293:Adolescent; D000328:Adult; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D016208:Databases, Factual / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics / Q000517:prevention & control; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D010389:Pemoline / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards; D011358:Product Surveillance, Postmarketing / Q000379:methods / Q000592:standards; D012308:Risk Management / Q000379:methods*; D012737:Sex Factors; D013997:Time Factors; D014481:United States; D014486:United States Food and Drug Administration / Q000331:legislation & jurisprudence / Q000592:standards
chemical_list: D000697:Central Nervous System Stimulants; D010389:Pemoline