{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:42:39Z","timestamp":1761561759084},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,5,23]],"date-time":"2013-05-23T00:00:00Z","timestamp":1369267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2014,6]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Managed healthcare organizations often utilize formulary management strategies such as prior authorization and step therapy to guide appropriate medication use and to control medication expenditures. The objective of this study was to examine clinical and economic outcomes associated with implementation of a pregabalin step therapy (ST<\/jats:styled-content>) policy among Medicare Advantage Prescription Drug (MAPD<\/jats:styled-content>) members.<\/jats:p><\/jats:sec>Methods<\/jats:title>Pharmacy and medical claims data from Humana (restricted cohort; ST policy implemented 01\/01\/2009) and Thomson Reuters MarketScan\u00ae<\/jats:sup> (unrestricted cohort) were analyzed for MAPD members aged 65 to 89\u00a0years receiving treatment for painful diabetic peripheral neuropathy (pDPN<\/jats:styled-content>), postherpetic neuralgia (PHN) or fibromyalgia (FM). Difference\u2010in\u2010differences (DID) was used to examine year\u2010over\u2010year changes in disease\u2010related and all\u2010cause utilization and costs. Regression analyses examined medication utilization and healthcare expenditures after controlling for between\u2010group compositional differences.<\/jats:p><\/jats:sec>Results<\/jats:title>We identified 13,911 members in the restricted cohort and matched to members from unrestricted health plans. FM (51.0%) and pDPN<\/jats:styled-content> (41.8%) were the most common diagnoses. Members in the unrestricted cohort were older and had a greater level of comorbidity than members in the restricted cohort. The restricted cohort demonstrated greater year\u2010over\u2010year decrease in pregabalin utilization and increase in year\u2010over\u2010year gabapentin utilization compared with the unrestricted cohort. ST restriction was associated with an increase in disease\u2010related pharmacy costs and a decrease in total medical costs for the restricted cohort compared with the unrestricted cohort. There was no difference between cohorts in total healthcare cost.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>After controlling for differences in age and comorbidity burden between the groups, implementation of a pregabalin ST<\/jats:styled-content> restriction was associated with increased disease\u2010related pharmacy costs and decreased total medical costs; however, there was no net difference in total healthcare cost or total pharmacy cost.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12073","type":"journal-article","created":{"date-parts":[[2013,5,23]],"date-time":"2013-05-23T12:50:18Z","timestamp":1369313418000},"page":"419-426","source":"Crossref","is-referenced-by-count":12,"title":["Impact of a Pregabalin Step Therapy Policy Among Medicare Advantage Beneficiaries"],"prefix":"10.1111","volume":"14","author":[{"given":"Brandon T.","family":"Suehs","sequence":"first","affiliation":[{"name":"Competitive Health Analytics Inc. Louisville Kentucky U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Louder","sequence":"additional","affiliation":[{"name":"Competitive Health Analytics Inc. Louisville Kentucky U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margarita","family":"Udall","sequence":"additional","affiliation":[{"name":"Pfizer Inc NewYork NewYork U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph C.","family":"Cappelleri","sequence":"additional","affiliation":[{"name":"Pfizer Inc NewYork NewYork U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashish V.","family":"Joshi","sequence":"additional","affiliation":[{"name":"Formerly with Pfizer Inc NewYork NewYork U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nick C.","family":"Patel","sequence":"additional","affiliation":[{"name":"Competitive Health Analytics Inc. Louisville Kentucky U.S.A"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,5,23]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2001.7.4.297"},{"key":"e_1_2_6_3_1","first-page":"143","article-title":"Pharmaceutical step\u2010therapy interventions: a critical review of the literature","volume":"17","author":"Motheral BR","year":"2011","journal-title":"J Manag Care Pharm."},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.21.1831"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22457"},{"key":"e_1_2_6_6_1","first-page":"S1","article-title":"Effect of 6 managed care pharmacy tools: a review of the literature","volume":"16","author":"Shoemaker SJ","year":"2011","journal-title":"J Manag Care Pharm."},{"key":"e_1_2_6_7_1","first-page":"123","article-title":"The effects of antihypertensive step\u2010therapy protocols on pharmaceutical and medical utilization and expenditures","volume":"15","author":"Mark TL","year":"2009","journal-title":"Am J Manag Care."},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2010.09060877"},{"key":"e_1_2_6_9_1","first-page":"154","article-title":"Impact of a prior authorization for pregabalin on health plan drug expenditures","volume":"16","author":"Bazalo G","year":"2010","journal-title":"Am J Manag Care."},{"key":"e_1_2_6_10_1","first-page":"e95","article-title":"Effects of a Medicaid prior authorization policy for pregabalin","volume":"15","author":"Margolis J","year":"2009","journal-title":"Am J Manag Care."},{"key":"e_1_2_6_11_1","first-page":"447","article-title":"Healthcare utilization and cost effects of prior authorization for pregabalin in commercial health plans","volume":"16","author":"Margolis J","year":"2010","journal-title":"Am J Manag Care."},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLR.0000064641.84967.B7"},{"key":"e_1_2_6_13_1","first-page":"110","article-title":"A comparison of comorbidity measurements to predict healthcare expenditures","volume":"12","author":"Farley JF","year":"2006","journal-title":"Am J Manag Care."},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4419-1742-3"},{"key":"e_1_2_6_15_1","volume-title":"SAS\u00ae for Mixed Models","author":"Littell RC","year":"2006"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1983.10478017"}],"container-title":["Pain Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpapr.12073","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/papr.12073","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T19:32:48Z","timestamp":1696275168000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/papr.12073"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,23]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2014,6]]}},"alternative-id":["10.1111\/papr.12073"],"URL":"https:\/\/doi.org\/10.1111\/papr.12073","archive":["Portico"],"relation":{},"ISSN":["1530-7085","1533-2500"],"issn-type":[{"value":"1530-7085","type":"print"},{"value":"1533-2500","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,5,23]]}}}