Examining the Impact of Medicaid's Prior Authorization Requirements for Tobacco Cessation Medications on Tobacco Cessation Medication Prescriptions

检查医疗补助计划对戒烟药物的事先授权要求对戒烟药物处方的影响

• 批准号: 10558258
• 负责人: Marcus Owen Dillender
• 金额: $ 7.93万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10558258
• 关键词: Administrator; Advocate; Affordable Care Act; Age; Behavior; Black Populations; Characteristics; Cigarette; Colorado; Counseling; Data; Data Set; Decision Making; Disparity; Drug Prescriptions; Ensure; Grant; Health; Health Policy; Healthcare; Hispanic Populations; Income; Insurance; Insurance Carriers; Knowledge; Low Income Population; Low income; Managed Care; Medicaid; National Cancer Institute; Nicotine; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Process; Public Health; Public Policy; Recommendation; Research; Research Priority; Smoke; Smoker; Smoking; System; Testing; Tobacco Use Cessation; cost effective; design; evidence base; improved; insight; low socioeconomic status; prior authorization; programs; reduce tobacco use; sex; smoking cessation

PROJECT SUMMARY/ABSTRACT Increasing access to tobacco cessation medications is a key part of U.S. health policy’s strategy for reducing smoking, especially for low-income smokers, who are less likely to use tobacco cessation medications than high-income smokers are. Given that the Affordable Care Act requires Medicaid programs to cover tobacco cessation medications, Medicaid coverage grants enrollees access to tobacco cessation medications in principle, but over two-thirds of state Medicaid programs require doctors to obtain prior authorization from program administrators before prescribing tobacco cessation medications. While prior authorization requirements’ advocates argue that requiring prior authorization can ensure appropriate and cost-effective prescribing without reducing access to helpful medications, even small prescribing hurdles have the potential to have large impacts on prescribing behavior and medication access. Public health leaders call for removing barriers in access to tobacco cessation medications, but it is not currently known if requiring prior authorization meaningfully reduces overall use of these medications or if it instead ensures appropriate use without reducing access more generally, as its advocates argue. This project proposes to estimate the impact of prior authorization requirements in Medicaid on the use of tobacco cessation medications by using detailed data on health care claims to study Colorado’s Medicaid program removing its prior authorization requirement for tobacco cessation medications in 2018. A primary objective of the proposed project is to estimate the impact of Colorado removing its prior authorization requirement on overall tobacco cessation prescriptions and related treatments. A second objective is to estimate heterogeneous impacts of removing prior authorization requirements for different demographic groups. The project then proposes to use the estimates to conduct additional analyses to assess the national implications of Medicaid programs requiring prior authorization for tobacco cessation medications. In addition, the project proposes to test for heterogeneous effects of prior authorization requirements based on prior health conditions to assess the claim that the main effect of prior authorization requirements is to avoid prescriptions that Medicaid programs could identify as potentially being inappropriate. Achieving these aims will provide stakeholders with information that can be used when making decisions about whether to require prior authorization for tobacco cessation medications and, conditional on requiring prior authorization, to set up systems and rules that improve the prior authorization process for tobacco cessation medications. Achieving the aims of this study will address multiple research priorities of the National Cancer Institute by increasing knowledge about barriers in access to evidenced-based cessation treatments, by identifying strategies to increase the use of cessation treatments for people with low socioeconomic status, and by providing insights into how insurers can contribute to tobacco cessation.

项目摘要/摘要 增加获得烟草戒烟药物的机会是美国卫生政策降低战略的关键部分 吸烟，尤其是对于低收入吸烟者而言，使用戒烟药物的可能性少于 高收入吸烟者是。鉴于《平价医疗法案》要求医疗补助计划覆盖烟草 戒烟药物，医疗补助覆盖赠款招募了使用烟草戒烟药物 原则，但超过三分之二的州医疗补助计划要求医生从 计划管理员开处方戒烟药物之前。在事先授权的同时 要求的拥护者认为，要求事先授权可以确保适当且经济有效 开处方而没有减少使用有用的药物的情况下，即使是小规定的障碍也有潜力 对处方行为和药物访问产生很大的影响。公共卫生领导人要求撤职 获得烟草戒烟药物的障碍，但目前尚不知道是否需要事先授权 有意义地减少了这些药物的总体使用，或者如果它确保适当使用而不减少 正如其倡导者所论证的那样，更普遍地访问。该项目提议估算先前的影响 医疗补助对使用烟草戒烟药物的授权要求，通过使用详细数据 医疗保健声称研究科罗拉多州的医疗补助计划，以删除其先前的授权要求 2018年的烟草戒烟药物。拟议项目的主要目的是估计 科罗拉多州删除了其先前的授权要求 治疗。第二个目标是估计删除事先授权的异质影响 对不同人口组的要求。然后，该项目提议使用估计值进行进行 其他分析以评估需要事先授权的医疗补助计划的国家含义 烟草戒烟药物。此外，该项目的提案要测试先验的异质效应 基于先前健康状况的授权要求评估先验的主要影响的主张 授权要求是避免处方医疗补助计划可能会识别为可能存在的处方 不当。实现这些目标将为利益相关者提供在制作时可以使用的信息 关于是否需要事先授权进行戒烟药物的决定，并以此为条件 需要事先授权，设置系统和规则，以改善 烟草戒烟药物。实现这项研究的目的将解决 国家癌症研究所通过增加有关障碍的知识，以获得基于经验的戒烟 治疗方法，通过确定增加对患有低人的戒烟治疗的策略 社会经济地位，并通过提供有关确保如何有助于烟草戒烟的见解。