Pain-Related Healthcare Costs

Cincinnati—In the recent past, there have been studies conducted to determine the effects of prior authorization (PA) programs in Medicaid and commercial health plans for Lyrica^® (pregabalin). The studies have provided evidence associating restrictions to access to pregabalin with increased or nonsignificantly affected pain-related healthcare utilization expenditures in patients with painful diabetic peripheral neuropathy (pDPN) or postherpetic neuralgia (PHN).

However, there been no studies examining the association between pregabalin access restrictions and pain-related healthcare expenditures in Medicare-eligible patients with fibromyalgia (FM). Researchers recently conducted a study designed to examine the association between pain-related healthcare expenditures and pregabalin PA or step therapy (ST) access restrictions, specifically in patients with pDPN, PHN, or FM, who have Medicare supplemental insurance.

They reported study results during a poster session at the AMCP meeting. The poster was titled Association between Pregabalin Access Restrictions and Pain-Related Healthcare Expenditures in Medicare Supplemental Health Plans.

This retrospective cohort study used a quasi-experimental posttest-only design with nonequivalent groups. Patients included in the study were required to have ≥1 inpatient or outpatient claim with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for DPN, PHN, or FM, continuous enrollment with pharmacy benefits, and be ≥65 years of age. Other inclusion criteria were least 1 claim for pain mediation used in treating pDPN, PHN, or FM for a pain intervention procedure within 60 days after any diagnosis of DPN, PHN, or FM, no residence in a long-term care facility for ≥90 total days, and no evidence of epilepsy, transplant surgery, or cancer.

The researchers found that in most cases, pregabalin access restrictions were associated with lower odds of pregabalin use but not overall savings on pain-related healthcare expenditures. Exceptions to this finding were PA associated with lower adjusted pain-related expenditures in the pDPN/PHN sample and ST associated with nonsignificantly different adjusted odds of pregabalin use in pDPN/PHN sample. Previous studies on this topic had congruent results.

Study limitations cited by the authors included the study methodology being limited by its cross-sectional design. Cross-sectional designs are less internally valid for policy evaluation than the difference-in-difference designs employed in the 2 prior studies of pregabalin access restrictions. The cross-sectional design was chosen for this study because data on the date of restriction implementation were unavailable.

This study was supported by Pfizer Inc.