ProHealth fibromyalgia Vitamin and Natural Supplement Store and Health
Log In  |  My Account  |  View Cart  View Your ProHealth Vitamin and Supplement Shopping Cart
800-366-6056  |  Contact Us  |  Help

|
|
|

Trending News

10 "Healthy" Foods That Are NOT Fibro-Friendly

VIDEO: What It Feels Like To Live With Fibro

Fibromyalgia “Is All in Your Head” and Other Abusive Nonsense

Could Cancer Research Improve the Treatment of Widespread Pain in Fibromyalgia and ME/CFS?

SURVEY: Patient Experience with Physicians

VIDEO: Treating Fibromyalgia with Oxytocin

Fibromyalgia Research Update from Integrated Tissue Dynamics

The Brain Boosting and Fatigue Fighting B-12

Fibromyalgia, Family and Friends: 8 Ways to Improve Relationships

Melatonin Regulates Inflammation Resolution in Fibromyalgia and Other Disorders

 
Print Page
Email Article

Does Using a Step Therapy Program for Pregabalin Reduce Healthcare Costs?

  [ 1 vote ]   [ Post a Comment ]
www.ProHealth.com • April 28, 2013


Editor's comment:  Step Therapy is a term used to describe a practice used by many insurance companies that requires physicians to begin drug therapy for a medical condition with the most cost-effective and safest drug therapy available, progressing to other more costly or risky therapy, only if necessary.  This practice is sometimes called Fail First because patients must try and fail to be helped by all of the less costly medications available before the insurance company will pay for a more expensive (usually brand-name) medication.  This study compares two groups of patients whose doctors wanted to prescribe pregabalin (Lyrica) for them.  One group was restricted to using the Step Therapy approach while the other group was unrestricted, meaning their doctors could prescribe pregabalin for them without having to try other medications first.  The objective of the study was to find out whether the Step Therapy approach was ultimately less expensive overall than an unrestricted approach.

Impact of a step-therapy protocol for pregabalin on healthcare utilization and expenditures in a commercial population.

By Margarita Udalla, et al.

Abstract:

Objective:
To compare changes in healthcare resource utilization and costs among members with painful diabetic peripheral neuropathy (pDPN), postherpetic neuralgia (PHN), or fibromyalgia (FM) in a commercial health plan implementing pregabalin step-therapy with members in unrestricted plans.

Methods:
Retrospective study of outcomes associated with implementation of a pregabalin step-therapy protocol using claims data from Humana ('restricted' cohort) and Thomson Reuters MarketScan ('unrestricted' cohort). Members aged 18-65 years receiving treatment for pDPN, PHN, or FM during 2008 or 2009 were identified; cohorts were matched on diagnosis and geographic region. Baseline to follow-up changes in healthcare resource utilization and costs were determined using difference-in-differences (DID) analysis. Statistical models adjusting for covariates explored relationships between restricted access and outcomes.

Results: A total of 3876 restricted cohort members were identified and matched to 3876 unrestricted cohort members. FM was the predominant diagnosis (84.7%). The unrestricted cohort was older (mean = 49.0 (SD = 10.4) years vs 47.6 (SD = 10.5) years; p < 0.001), and had greater comorbidity (RxRisk-V score = 5.4 (SD = 3.2) vs 4.4 (SD = 2.9), p < 0.001) than the restricted cohort.

  • Compared with the unrestricted cohort, the restricted cohort demonstrated a greater year-over-year decrease in pregabalin utilization (-2.6%, p = 0.008), and greater increases in physical therapy and disease-related outpatient utilization (3.7%, p = 0.010 and 3.6%, p = 0.022, respectively).

  • There were no statistically significant net differences in all-cause or disease-related total healthcare, medical, or pharmacy costs between cohorts.

  • After adjusting for baseline compositional differences between cohorts, restricted plan membership was associated with a net increase in all-cause medical ($1222; p = 0.016) and disease-related healthcare costs ($859; p = 0.002).

Limitations include use of a combined analysis for pDPN, PHN, and FM, especially since the observed results were likely driven by FM; an inability to link the prescribing of a medication with the condition of interest, which is common to claims analyses; and lack of pain severity information.

Conclusions: Implementation of a pregabalin step-therapy protocol resulted in lower pregabalin utilization, but this restriction was not associated with reductions in total healthcare costs, medical costs, or pharmacy costs.

Source:  Journal of Medical Economics, Epub April 26, 2013. By Margarita Udalla, Anthony Louderb, Brandon T. Suehsb, Joseph C. Cappelleria, Ashish V. Joshic and Nick C. Patel. Pfizer Inc , New York, NY , USA.




Join the Discussion Post a Comment 




[ Be the first to comment on this article ]




 
Free Chronic Fatigue Syndrome and Fibromyalgia Newsletters
Subscribe to
Our FREE
Newsletter
Subscribe Now!
Receive up-to-date ME/CFS & Fibromyalgia treatment and research news
 Privacy Guaranteed  |  View Archives

Save on Your Next Order

Featured Products

Fibro Freedom™ Fibro Freedom™
Soothes, strengthens & revitalizes
FibroSleep™ by ProHealth FibroSleep™ by ProHealth
The All-in-One Natural Sleep Aid
Guaifenesin FA™ Guaifenesin FA™
Natural Expectorant Relieves Chest Congestion
B-12 Extreme™ B-12 Extreme™
The Most Potent Vitamin B-12 on Earth
Hydroxocobalamin Extreme™ Hydroxocobalamin Extreme™
The B-12 your brain needs for detox & sharpness

Natural Remedies

Why Berries Offer a Rainbow of Health Benefits Why Berries Offer a Rainbow of Health Benefits
Protecting Our Eyes Against Time-Induced Damage Protecting Our Eyes Against Time-Induced Damage
Itching to Find Dry Skin Relief? Itching to Find Dry Skin Relief?
Sunshine Vitamin Has D-lightful Health Benefits Sunshine Vitamin Has D-lightful Health Benefits
The Big Blue Fish that Helps Chase the Blues Away The Big Blue Fish that Helps Chase the Blues Away

FIBROMYALGIA RESOURCES
What is Fibromyalgia?
Fibromyalgia 101
Fibromyalgia Symptoms
Fibromyalgia Treatments
| CFS RESOURCES
What is CFS?
ME/CFS 101
ME/CFS Symptoms
ME/CFS Treatments
| FORUMS
Fibromyalgia
ME/CFS
ADVANCED MEDICAL LABS
WHOLESALE  |  AFFILIATES
GUARANTEE
CONTACT US
PRIVACY
RSS
SITE MAP
ProHealth on Facebook  ProHealth on Twitter  ProHealth on Pinterest  ProHealth on Google Plus
Credit Card Processing