Do Prior Authorization Policies Discourage First-Line Antipsychotic Use in Patients Newly Discharged from a Hospitalization for Schizophrenia in Saskatchewan?

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David F Blackburn
David Tran
Alex Crawley
Sarah Lynds
Anne Champagne
Lauren Bresee

Keywords

Antipsychotics, schizophrenia, health policy, prior authorization

Abstract

Background


Drug benefit providers can decrease prescribing of specific medications through p rior authorization policies. In Saskatchewan , certain second generation antipsychotics (SGAs) are recognized as first - line agents to manage schizophrenia ; but , require prior authorization because their coverage is restricted in other conditions. We aimed to determine if the need for prior - authorization substantially diminishes prescribing of first - line SGAs in comparison to unrestricted agents.


Objectives


To conduct an ecological comparison of SGA prescrib ing with changes in prior - authorization policies between 1997 and 2005 using health - administrative databases in Saskatchewan , Canada . Method Eligible subjects were discharged from hospital with a first - time primary diagnosis of schizophrenia between 199 7 and 2005. SGAs dispensed within 7 days of discharge were used to estimate prescribing preferences for olanzapine and quetiapine relative to risperidone. Percentages of SGA use were age and sex standardized to the 2000 cohort.


Results


Out of 1,277 eligible patients, 521 (41%) received 564 SGA dispensations within 7 - days of hospital discharge. Between 1997 and 1998, risperidone was the only SGA covered for first - line use and made up 72.6% (82/113) of SGA use while olanzapine made up 27.4% (31/113) fo r a crude preference ratio of 0.38 (27 . 4/72 . 6). Risperidone use decreased to 65.8% in 1999 - 2002 and to 47.4% in 2003 - 2005 as a percentage of SGA dispensations. Correspondingly, the preference ratios for olanzapine and quetiapine increased from 0.40 to 0.57 and from 0.12 to 0.54 in these respective p eriods.


Conclusions


The requirement for prior - authorization does not appear to substantially diminish prescribing of first - line SGAs for the treatment of schizophrenia in Saskatchewan , Canada .

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