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

Main Article Content

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


Antipsychotics, schizophrenia, health policy, prior authorization



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.


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.


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.


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

Abstract 9 | PDF Downloads 0


1. Verdoux H, Tournier M, Begaud B. Antipsychotic prescribing trends: a review of pharmaco - epidemiological studies. Acta Psychiatr Scand 2010;121:4 - 10.
2. Alessi - Severini S, Biscontri RG, Collins DM, Kozyrskyj A, Sareen J, Enns MW. Utilization and costs of antipyschotic agents: a Canadian population - based study, 1996 - 2006. Psychiatr Serv 2 008;59(5):547 - 53.
3. Law MR, Ross - Degnan D, Soumerai SB. Effect of prior authorization of second - generation antipsychotic agents on pharmacy utilization and reimbursements. Psychiatr Serv 2008;59:540 - 6.
4. Soumerai SB, Zhang F, Ross - Degnan D, et al. Use of atypi cal antipsychotic drugs for schizophrenia in Maine Medicaid following a policy change. Health Aff 2008;27(3):185 - 95.
5. Zhang Y, Adams AS, Ross - Degnan D, Zhang F, Soumerai SB. Effects of prior authorization on medication discontinuation among Medicaid benefic iaries with bipolar disorder. Psychiatr Serv 2009;60:520 - 7.
6. Downey W, Stang MR, Beck P, Osei W, Nichol JL. Health Services Databases in Saskatchewan, in Pharmacoepidemiology. John Wiley & Sons Ltd. 2007; Fourth Edition (ed B L Strom).
7. Jackevicius CA, Li P, Tu JV. Prevalence, predicators and outcomes of primary nonadherence after acute m yocardi al i nfarction. Circulation 2008;117:1028.
8. Statistics Canada. 2011 Standard Geographical Classification (SGC). Catalogue no. 12 - 571 - X. 2011;1.
9. Perepelkin J, Dobson R. P erceptions of Saskatchewan community pharmacists regarding a prior authorization program. J Manag Care Pharm 2007;13:589 - 97.
10. Saskatchewan Ministry of Health. Exception Drug Status. http://w - drug - status . Accessed June 28, 2013.
11. Rawson N, Malcolm E, Darcy C. Reliability of the recording of schizophrenia and depressive disorder in the Saskatchewan health care datafiles. Soc Psychiatry Psychiatr Epidemiol 1997;32:191 - 9.