title: Review of outcomes associated with restricted access to atypical antipsychotics.
abstract: Cost containment policies, such as prior authorization (PA), have increasingly been used by formulary decision makers to manage drug spending of the atypical antipsychotic (AAP) drug class. However, these drug cost containment policies may result in cost shifting rather than cost savings. Given the interest in coordination of care, the objective of this study was to evaluate the impact of restricted access to AAPs on healthcare costs and health outcomes in individuals with schizophrenia or bipolar disorder.
  
  
  
  Narrative literature review.
  
  
  
  A literature search was conducted using MEDLINE (via PubMed) for studies published between January 1993 and December 2013.
  
  
  
  A total of 15 published studies were identified that evaluated restricted access to AAPs in regard to healthcare costs or health outcomes: 11 studies assessed PAs, 2 studies assessed carve-outs, 1 study assessed a payment limit (cap), and 1 study assessed Medicare Part D cost sharing. Among 8 studies evaluating changes in pharmacy costs and clinical outcomes, 5 studies reported that formulary restrictions were associated with pharmacy cost savings and increases in healthcare utilization or treatment discontinuation. Of the 4 studies that measured overall cost changes, 3 studies reported increases in overall cost burden and 1 study showed modest cost savings associated with formulary restrictions.
  
  
  
  Study findings revealed there exists a gap in the literature as to whether restricted access to AAPs results in overall cost savings or, rather, shifts the cost burden from pharmacy spending to other parts of the healthcare system, such as service utilization.
authors.forename: Krithika
authors.initials: K
authors.lastname: Rajagopalan
authors.forename: Marjam
authors.initials: M
authors.lastname: Hassan
authors.affiliation: 4114 Woodlands Pkwy, Ste 500, Palm Harbor, FL 34685. E-mail: kim.boswell@xcenda.com.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Boswell
authors.forename: Evelyn
authors.initials: E
authors.lastname: Sarnes
authors.forename: Kellie
authors.initials: K
authors.lastname: Meyer
authors.forename: Fred
authors.initials: F
authors.lastname: Grossman
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000191:economics* / Q000494:pharmacology*; D016527:Drug Costs; D005260:Female; D005102:Health Expenditures; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics*; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D008484:Medicaid / Q000191:economics; D054524:Medicare Part D / Q000191:economics; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy*; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D055553:Prescription Drugs / Q000191:economics / Q000494:pharmacology; D014481:United States
chemical_list: D014150:Antipsychotic Agents; D055553:Prescription Drugs