title: Evaluation of an automated system for prior authorization: a COX-2 inhibitor example.
abstract: OBJECTIVE
  To evaluate the effectiveness of an automated prior authorization (PA) system (SmartPA) in reducing use of and expenditures for cyclooxygenase-2 (COX-2) inhibitors.
  
  
  METHODS
  Before and after with control group.
  
  
  METHODS
  After implementation of SmartPA in Missouri, changes in use of and expenditures for COX-2 inhibitors, COX-2 substitutes (traditional nonsteroidal anti-inflammatory drugs [NSAIDs] and other products for pain), and gastrointestinal (GI) protective agents were compared between the Medicaid program of Missouri and that of a state with no PA program for COX-2 inhibitors. Subjects were continuously enrolled for the 24-month study period and had a claim for a COX-2 inhibitor in the 12-month baseline period. Analyses included comparison of means and linear regression. Regressions controlled for age, sex, risk for GI complications, severity of illness, and the interaction between state and risk.
  
  
  RESULTS
  Changes in expenditures for COX-2 inhibitors, NSAIDs, other pain drugs, and GI-protective drugs were $256 higher, $56 lower, $21 higher, and $198 higher, respectively, in the control state among low-risk patients. Changes in expenditures were $102 higher, $12 lower, $21 lower, and $185 higher, respectively, in the control state among high-risk patients. Results were similar for drug utilization.
  
  
  CONCLUSIONS
  Implementation of SmartPA resulted in reduced use of and expenditures for COX-2 inhibitors and reduced net expenditures for all pain and GI-protective medications. These effects were greatest for patients at low risk for GI complications.
authors.affiliation: Division of Pharmacy Administration, School of Pharmacy, Virginia Commonwealth University, 410 N 12th St, PO Box 980533, Richmond, VA 23298-0533, USA. nvcarroll@vcu.edu
authors.forename: Norman V
authors.initials: NV
authors.lastname: Carroll
authors.forename: Jeff C
authors.initials: JC
authors.lastname: Smith
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berringer
authors.forename: George L
authors.initials: GL
authors.lastname: Oestreich
mesh_terms: D000368:Aged; D003363:Cost Control / Q000379:methods; D052246:Cyclooxygenase 2 Inhibitors / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D008297:Male; D008484:Medicaid; D008509:Medication Systems / Q000458:organization & administration*; D008875:Middle Aged; D008923:Missouri
chemical_list: D052246:Cyclooxygenase 2 Inhibitors