Health Affairs

Health Affairs, 26, no. 3 (2007): 750-760 doi: 10.1377/hlthaff.26.3.750 © 2007 by Project HOPE	New Online   Getting Health Reform Done   After the State of the Union   Incremental Reform   E-Health in Developing World   Most-Read Articles in 2009

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Case Studies

Medicaid’s Prior Authorization Program And Access To Atypical Antipsychotic Medications

Jennifer M. Polinski, Philip S. Wang and Michael A. Fischer

State Medicaid programs use prior authorization (PA) to control drug spending by requiring that specific conditions be met before allowing reimbursement. The extent to which PA policies respond to new developments concerning medication safety is not known. In April 2005 the Food and Drug Administration (FDA) issued an advisory describing increased mortality among elderly people with dementia taking atypical antipsychotics. More than a year later, no state had changed its PA policy in response. We discuss the roles of Medicaid and other insurers in responding to emerging drug safety issues and their challenges in weighing drug risks and benefits.

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