Assessment of the impact of the West Virginia Medicaid's prior authorization policy for NSAIDs on chronic patients [electronic resource] : economic and humanistic outcomes /

by Momani, Aiman A.

Assessment of the Impact of the West Virginia Medicaid's Prior Authorization Policy for NSAIDs on Chronic Patients: Economic and Humanistic Outcomes Aiman A. Momani The West Virginia Medicaid prior authorization (PA) policy requires patients to have tried and failed two different classes of generic NSAIDs for two weeks each before a branded NSAID is approved. However, the implementation of PA may lead to increase in utilization and cost of unrestricted medications and/or medical services and compromise patient care. Therefore, the goals of the study were: (1) to assess the net economic impact of PA for NSAIDs, and (2) to determine the impact of the policy on patients' health-related quality of life (HRQoL). The study was conducted in two phases. In phase I, retrospective utilization and expenditures data were analyzed of recipients with continuous Medicaid enrollment over the 3-year period of the study, who were diagnosed with rheumatoid arthritis, osteoarthritis, spondylitis, and chronic pain syndromes. Time series analysis was used to model the impact of the policy. In Phase II, a randomly selected sample of patients who were diagnosed with the above mentioned disorders, and who have been prescribed an NSAID product was identified. Patients were classified into two groups based on whether or not they were approved the use of a branded NSAID. HRQoL was measured at the time the patient was identified and at two months after baseline using a modified version of the Arthritis Impact Measurement Scales (AIMS). Results indicate that the policy was associated with: (i) increased overall rate of utilization and expenditures for NSAIDs; (ii) increased rate of utilization of unrestricted drugs including GI medications, narcotic analgesics, and non-narcotic analgesics; (iii) increased rate of monthly expenditures for outpatient hospital services; (iv) increased level of utilization of health clinic services; and (vi) increased rate of utilization of physician visits. However, these effects cannot be generalized to elderly patients or to those who used NSAIDs for acute health conditions. In regard to patients' HRQoL, findings reveal that the use of generic NSAIDs did not result in a negative impact on the HRQoL for patients. For patients who were approved a branded NSAID, improvement were detected on several domains of HRQoL including mobility, hand and finger function, walking and bending, and social activities. iii