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Nevo ON, Gold J, Hawk S. Evaluation of a prior authorization policy on compliance with VA pharmacy benefits management services recommendations for antipsychotic selection. Ment Health Clin 2015. [DOI: 10.9740/mhc.2015.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction:
A previous study at Veterans Affairs (VA) Eastern Colorado Health Care System revealed low rates of compliance with VA Pharmacy Benefits Management Services recommendations for antipsychotic selection in schizophrenia and schizoaffective disorders. As a result, formulary restrictions of second-line antipsychotics were implemented. Since April 2013, new starts of second-line antipsychotic agents require a prior authorization drug review. The objectives of this study were to evaluate the impact of the prior authorization process on compliance with the VA criteria for prescribing aripiprazole, olanzapine, and ziprasidone. The primary objective was to compare compliance rates with VA antipsychotic selection criteria preimplementation and postimplementation of the prior authorization drug review policy.
Methods
Single center, retrospective chart review of patients receiving aripiprazole, olanzapine, and ziprasidone. A report of all patients receiving a prescription for the above 3 agents between April 8, 2013, and December 6, 2013, was generated from the electronic medical record system. Charts were reviewed manually to determine compliance.
Results
One hundred forty-two unique patients were started on aripiprazole, olanzapine, and/or ziprasidone. Ninety percent of patients met VA criteria for use of these second-line antipsychotic agents, compared to 26% of patients prior to implementation of the prior authorization drug review. Overall prescribing of these agents decreased by 60%, resulting in an estimated cost avoidance of $617 389.
Discussion
Implementation of a prior authorization drug request for aripiprazole, olanzapine, and ziprasidone was associated with increased compliance with VA criteria for use of antipsychotic agents and with marked cost avoidance due to the reduced use of more expensive second-line antipsychotic agents.
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Affiliation(s)
- Ofir Noah Nevo
- (Corresponding author) PGY2 Psychiatric Pharmacy Resident, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado,
| | - Jeffrey Gold
- Mental Health Clinical Pharmacy Specialist, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Sherri Hawk
- Pharmacoeconomist and Clinical Pharmacist, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
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