title: Utilization management for smoking cessation pharmacotherapy: varenicline rejected claims analysis.
abstract: OBJECTIVE
  To evaluate the impact of utilization management methods on use of smoking cessation medication.
  
  
  METHODS
  Retrospective cohort analysis of pharmacy claims data.
  
  
  METHODS
  The study population included patients at least 18 years of age, naive to varenicline, and with a rejected varenicline claim between January 2007 and April 2008 because of 1 of 4 utilization management restrictions: drug not covered, prior authorization, step therapy, or quantity limits. The outcome variable was whether patients used any smoking cessation medication including varenicline, bupropion, and nicotine replacement therapy (prescribed and over-the-counter) within 6 months of the rejected varenicline claim. Multivariable logistic regression was conducted to evaluate the probability of filling a prescription for any smoking cessation medication.
  
  
  RESULTS
  A total of 15,597 patients were identified. Within 6 months after the rejected claims, 8393 (53.8%) patients filled at least 1 smoking cessation medication, 7864 (93.7%) of whom filled varenicline. Compared with quantity limits, the odds ratios for filling any smoking cessation medication after the rejected varenicline claim were 0.01 (95% confidence interval [CI], 0.01-0.02) for varenicline not covered, 0.07 (95% CI, 0.06-0.09) for step therapy, and 0.18 (95% CI, 0.16-0.20) for prior authorization. Higher out-of-pocket expense was associated with a lower probability of filling any smoking cessation medication.
  
  
  CONCLUSIONS
  About half of the patients in this study did not fill any smoking cessation medication following a rejected varenicline claim. It is important to address this treatment gap in support of patients seeking smoking cessation therapy.
authors.affiliation: MedImpact Healthcare Systems, Inc, San Diego, CA 92131, USA. fzeng@medimpact.com
authors.forename: Feng
authors.initials: F
authors.lastname: Zeng
authors.forename: Chieh-I
authors.initials: CI
authors.lastname: Chen
authors.forename: Vera
authors.initials: V
authors.lastname: Mastey
authors.forename: Kelly H
authors.initials: KH
authors.lastname: Zou
authors.forename: James
authors.initials: J
authors.lastname: Harnett
authors.forename: Bimal V
authors.initials: BV
authors.lastname: Patel
mesh_terms: D000328:Adult; D001552:Benzazepines / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D018722:Nicotinic Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D011810:Quinoxalines / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016540:Smoking Cessation / Q000379:methods*; D014481:United States; D000068580:Varenicline
chemical_list: D001552:Benzazepines; D018722:Nicotinic Agonists; D011810:Quinoxalines; D000068580:Varenicline