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Jennifer M. Polinski, Philip S. Wang, and Michael A. Fischer Medicaid’s Prior Authorization Program And Access To Atypical Antipsychotic Medications Health Affairs, May/June 2007; 26(3): 750-760. [Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]

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Medicaid’s Lack of Response to New Drug Safety Issues

Robert A. Berringer, Doug Brink   ( 13 June 2007 )

Are Resources The Only Limiting Factor?

Susan L Parker   ( 28 November 2007 )

Medicaid’s Lack of Response to New Drug Safety Issues 13 June 2007
Robert A. Berringer, Director, Clinical Services ACS Health Management Solutions, Doug Brink Send comment to journal: Re: Medicaid’s Lack of Response to New Drug Safety Issues robert.berringer{at}acs-inc.com Robert A. Berringer, et al.	Jennifer Polinski and colleagues reported that no Medicaid programs changed their atypical antipsychotic prior authorization (PA) policy to address the April 2005 atypical antipsychotic FDA advisory. They also made five policy recommendations for states to consider in responding to new drug safety issues. While evidence-based resources translate research into policy and practice, current PA programs for some states have limitations and are not able to minimize risk and permit drug safety policy implementation. ACS Health Management Solutions (ACS) has developed two tools that balance clinical need with safety-related issues and minimize risk in this vulnerable population. SmartPASM is an automated PA system that queries a patient’s complete pharmacy and medical claims history when a claim is submitted by a pharmacy.[1] This system transparently approves therapy when the patient has clinical need (e.g., antipsychotic use in patients with history of schizophrenia) and also denies therapy in patients with drug-safety issues (e.g., antipsychotic use in elderly patients with history of dementia but no psychosis). Traditional PA programs do not query a patient’s complete history at the point of sale and result in the implementation of less selective policies (e.g., exempt all patients based on where they reside or their age). Twelve Medicaid programs currently use this automated PA system and are addressing selected drug-safety issues. For example, patients with a history of ischemic heart disease, peripheral vascular syndromes, cerebrovascular disease, or malignant hypertension in the last 2 years are denied triptan therapy. CyberAccessSM is a web-based electronic health record that integrates SmartPA. This technology provides prescribers a decision of clinical need or drug safety while the patient is still in office and before the prescription is written or electronically submitted to a pharmacy, minimizing risk even further. Some Medicaid programs have implemented technological solutions allowing them to respond to drug safety issues. Note 1.N.V. Carroll, et al. Evaluation of an Automated System for Prior Authorization: A COX-2 Inhibitor Example. Am J Manag Care. 2006;12:501-508.
Are Resources The Only Limiting Factor? 28 November 2007
Susan L Parker, Pharmacy Consultant Iowa Medicaid Send comment to journal: Re: Are Resources The Only Limiting Factor? sparker2{at}dhs.state.ia.us Susan L Parker	While this assessment focuses on whether Medicaid programs have the "resources" to respond to new drug safety issues, resources are not the only limiting factor. The more important factor is, is the Medicaid program "prohibited" from limiting access in any manner to these medications? The mental health drugs are typically "hands-off" per legislative mandates for the Medicaid programs. Therefore, this assessment is not an accurate reflection of how Medicaid programs address safety issues associated with new or old drugs.