title: Impact of Medicaid prior authorization on angiotensin-receptor blockers: can policy promote rational prescribing?
abstract: Prescription drug cost containment is a key health policy priority. State Medicaid programs have implemented policies requiring prior authorization before paying for angiotensin-receptor blockers (ARBs), a costly class of blood pressure medications. We examined the impact of these policies on drug use. We found that policies using a stepped-therapy approach reduced ARB use by 1.6 percent when first implemented and decreased the subsequent trend in ARB use by 1.3 percent per quarter; alternative approaches were unsuccessful. These findings have important implications for the development of rational drug reimbursement policy under Medicare Part D and other health insurance plans.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA. mfischer@partners.org
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fischer
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D017723:Drug Utilization Review; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms; D014481:United States
chemical_list: D057911:Angiotensin Receptor Antagonists; D000959:Antihypertensive Agents