title: Impact of a pregabalin step therapy policy among medicare advantage beneficiaries.
abstract: BACKGROUND
  Managed healthcare organizations often utilize formulary management strategies such as prior authorization and step therapy to guide appropriate medication use and to control medication expenditures. The objective of this study was to examine clinical and economic outcomes associated with implementation of a pregabalin step therapy (ST) policy among Medicare Advantage Prescription Drug (MAPD) members.
  
  
  METHODS
  Pharmacy and medical claims data from Humana (restricted cohort; ST policy implemented 01/01/2009) and Thomson Reuters MarketScan(®) (unrestricted cohort) were analyzed for MAPD members aged 65 to 89 years receiving treatment for painful diabetic peripheral neuropathy (pDPN), postherpetic neuralgia (PHN) or fibromyalgia (FM). Difference-in-differences (DID) was used to examine year-over-year changes in disease-related and all-cause utilization and costs. Regression analyses examined medication utilization and healthcare expenditures after controlling for between-group compositional differences.
  
  
  RESULTS
  We identified 13,911 members in the restricted cohort and matched to members from unrestricted health plans. FM (51.0%) and pDPN (41.8%) were the most common diagnoses. Members in the unrestricted cohort were older and had a greater level of comorbidity than members in the restricted cohort. The restricted cohort demonstrated greater year-over-year decrease in pregabalin utilization and increase in year-over-year gabapentin utilization compared with the unrestricted cohort. ST restriction was associated with an increase in disease-related pharmacy costs and a decrease in total medical costs for the restricted cohort compared with the unrestricted cohort. There was no difference between cohorts in total healthcare cost.
  
  
  CONCLUSIONS
  After controlling for differences in age and comorbidity burden between the groups, implementation of a pregabalin ST restriction was associated with increased disease-related pharmacy costs and decreased total medical costs; however, there was no net difference in total healthcare cost or total pharmacy cost.
authors.affiliation: Competitive Health Analytics Inc., Louisville, Kentucky, U.S.A.
authors.forename: Brandon T
authors.initials: BT
authors.lastname: Suehs
authors.forename: Anthony
authors.initials: A
authors.lastname: Louder
authors.forename: Margarita
authors.initials: M
authors.lastname: Udall
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cappelleri
authors.forename: Ashish V
authors.initials: AV
authors.lastname: Joshi
authors.forename: Nick C
authors.initials: NC
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000191:economics; D015331:Cohort Studies; D004334:Drug Administration Schedule; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D008297:Male; D020398:Medicare Part C / Q000191:economics*; D010146:Pain / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D000069583:Pregabalin; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics
chemical_list: D000700:Analgesics; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid
keywords: diabetic neuropathy, painful; fibromyalgia; formulary policy; postherpetic neuralgia; pregabalin