Navigation Links
Medicaid policies vary widely for rheumatoid arthritis drugs
Date:11/4/2008

Patients with inflammatory diseases such as rheumatoid arthritis now have many more treatment options than in the past, including biologic disease-modifying antirheumatic drugs (DMARDs). These drugs, derived by modifying substances found in humans or animals, slow progression of the disease rather than simply treating the symptoms. The cost of biologic DMARDs is a major concern because a one month's supply may cost 100 times more than a year's supply of older, non-biologic DMARDs.

While Medicaid regulations do not permit states to completely exclude subsets of drugs, they are able to implement policies controlling the use of selected medications. Prior authorization is one commonly used tool for containing drug spending, with the goal of allowing access to these medications for selected patients while avoiding inappropriate use in others. However, little is known about how such policies are developed or how they affect drug use. A new study examined Medicaid prior authorization policies for biologic DMARDs along with use of selected medications before and after policy implementation. The study was published in the November issue of Arthritis Care & Research (http://www3.interscience.wiley.com/journal/77005015/home).

Led by Dr. Michael A. Fischer of Brigham and Women's Hospital and Harvard Medical School, researchers collected data from 49 states and the District of Columbia to determine whether their Medicaid programs had a prior authorization policy for six biologic DMARDs between 1999 and 2005 (before Medicare Part D). For those that had one, they determined which medications required authorization, when the policy had been implemented and what criteria needed to be met for payment to be approved. The study also included data from the Centers for Medicare and Medicaid Services on drug utilization by Medicaid programs, including all outpatient prescriptions for which Medicaid provided reimbursement.

The results showed that 32 states had implemented or planned to implement Medicaid prior authorization policies for biologic DMARDs, with wide variability as to which drugs were included and the criteria required both in terms of the amount of detail requested and how authorization was determined. In 1999, total Medicaid spending on DMARDs was just over $200 million, a figure which increased to $567 million in 2005. The study also showed that states with prior authorization programs in place at the beginning of the study period had relatively low use of biologic DMARDs initially, but use increased sharply over the years studied, which raises a question about the sustainability of such policies.

"Our results have implications for prescription drug reimbursement policy, both for Medicaid and for other programs," the authors state. For Medicaid, they acknowledge that while clinical decisions regarding the use of biologic DMARDs for inflammatory diseases are complex, the wide variability in authorization criteria reveals limitations in policy development. "It is not clear how state agencies determine which clinical factors are included in the prior authorization rules or how closely these rules adhere to clinical evidence," they note, which may be of particular concern with the transition of many patients to the Medicare Part D program as it would be likely to complicate their care.

"Policy-makers must weigh the costs imposed by these policies in terms of professional time and patient delays of therapy against potential savings on these expensive medications," the authors conclude, adding that further examination "will be critical to fostering the development of more rational policies in the future, for Medicaid and for all drug insurance programs."


'/>"/>

Contact: Sean Wagner
swagner@wiley.com
781-388-8550
Wiley-Blackwell
Source:Eurekalert

Related medicine news :

1. Top 25 Managed Care Organizations Lead Increases in Managed Care Medicaid Enrollment Nationally, Though Hold Only One-Third of Its Enrollment
2. New National Medicaid Study Underscores Importance of Including State Relief in Stimulus Plan
3. ACS Signs $27 Million Contract with Alaska to Transition Fiscal Agent Services for State Medicaid Program
4. Cancer screening rates among older Medicaid patients fall short of national objectives
5. Bull Continues Repositioning and Announces the Acquisition of its Medicaid Solutions Business in the United States by Ingenix
6. Walgreens Pays U.S. $9.9 Million to Settle Medicaid Prescription Drug Allegations
7. State Medicaid Programs to Spend $1.6 Trillion on Long-Term Care over the Next Twenty Years
8. ADA Asks Congress to Strengthen Medicaid Oral Health Programs
9. MEDais Predictive Analytics Impact How State Medicaid Agencies Triage High- Risk Members
10. Amerigroup Settles Federal and State Medicaid Fraud Claims for $225 Million
11. Government Ill-Equipped to Prevent Medicaid Fraud, Says False Claims Act Expert
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/27/2016)... ... May 27, 2016 , ... Aimed at nurses and employees in the health ... of leaders in the nursing and health care industry. It also provides insight to ... Christian University. , As the nursing industry is coming out of one of ...
(Date:5/26/2016)... ... 26, 2016 , ... Despite last week’s media reports hinting at a June ... wait until March 2017 for an interest rate increase, according to Rajeev Dhawan of ... , “The Federal Open Market Committee (FOMC) dot charts are of interest to the ...
(Date:5/26/2016)... ... May 26, 2016 , ... Cabot Corporation, Pfizer, and ... according to court documents and SEC filings. A jury has returned a ... American Optical Corporation, Case No. BC588866, Los Angeles County, California. The jury awarded ...
(Date:5/26/2016)... ... 2016 , ... Connor Sports, through its Connor Cares initiative, will ... Tamika Catchings Legacy Tour that will commemorate the Indiana Fever legend’s hall-of-fame career ... all forms and levels of the game, Connor Sports has committed to a significantly ...
(Date:5/26/2016)... (PRWEB) , ... May 26, 2016 , ... ... one that has a significant negative impact on long-term patient survival, reports a ... The results, published online this week in the Journal of Thoracic and Cardiovascular ...
Breaking Medicine News(10 mins):
(Date:5/24/2016)... 2016 Cirujanos holandeses han puesto ... los médicos a compartir sus mejores prácticas por el ... Profesionales médicos de Europa, África, Asia ... la aplicación, que combina la transmisión en vivo con ... Educación   "Imagine un médico de ...
(Date:5/24/2016)... Mass. , May 24, 2016  NxStage Medical, ... technology company focused on advancing renal care, today announced ... plans to participate in the following schedule of investor ... be made available at http://ir.nxstage.com/ . ... Jefferies Healthcare Conference NY, NY           Friday, June ...
(Date:5/24/2016)... HONG KONG , May 24, 2016 ... de COMBO ™ , la ... présentent des cathéters destinés à l,intervention portant ... artério-veineuse (FAV)   OrbusNeich, entreprise ... vasculaires permettant de changer la vie, a ...
Breaking Medicine Technology: