Prior authorization in the treatment of patients with pDPN and FM.
OBJECTIVE
To determine prior authorization (PA) impact on healthcare utilization, costs, and pharmacologic treatment patterns for painful diabetic peripheral neuropathy (pDPN) and fibromyalgia (FM).


METHODS
This retrospective, observational, longitudinal cohort study used medical and pharmacy claims data. Newly diagnosed patients treated for FM or pDPN between 7/1/2007 and 12/31/2011 were included. PA and no PA groups were matched by propensity score 4:1. Medical resource utilization, direct medical and pharmacy costs, and treatment pattern differences were compared. Pre and postindex differences between PA and no PA cohorts were determined by difference in difference analysis.


RESULTS
Analysis of 2,315 FM patients (1,852 PA; 463 no PA) demonstrated greater increases in postindex all-cause costs ($197; P = 0.6673) and disease-related costs ($72; P = 0.4186) in the PA cohort. Analysis of 1,300 pDPN patients (1,040 PA; 260 no PA) demonstrated postindex all-cause cost increases of $1,155 more in the no PA cohort (P = 0.6248); disease-related costs decreased $2,809 more in the no PA cohort (P = 0.4312). Treatment patterns were similar between cohorts; opioid usage was higher in the FM PA cohort (P = 0.0082).


CONCLUSIONS
There was no evidence of statistically significant differences between PA and no PA cohorts in either FM or pDPN populations for total all-cause or disease-related costs.
Industry Sponsored Research, HealthCore, Inc., Andover, Massachusetts, U.S.A.
Hilary E D
HE
Placzek
Elizabeth T
ET
Masters
Tao
T
Gu
Joseph C
JC
Cappelleri
Thomas E
TE
Wasser
Andrew G
AG
Clair
Joseph P
JP
Cook
Debra F
DF
Eisenberg
D000328:Adult; D000368:Aged; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D017281:Cost of Illness; D003521:Cyclopropanes / Q000191:economics / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000191:economics; D000068736:Duloxetine Hydrochloride / Q000191:economics / Q000627:therapeutic use; D005260:Female; D005356:Fibromyalgia / Q000188:drug therapy*; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health; D007356:Insurance, Pharmaceutical Services; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000078764:Milnacipran; D000069583:Pregabalin / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use
D000700:Analgesics; D003521:Cyclopropanes; D000068736:Duloxetine Hydrochloride; D000078764:Milnacipran; D000069583:Pregabalin; D017367:Selective Serotonin Reuptake Inhibitors
diabetic neuropathy; fibromyalgia; healthcare utilization; pain; pharmacologic treatment; prior authorization