502 The effects of removing the requirement for prior reimbursement approval on anticoagulant use in Ireland: A cross sectional study. (13th April 2023)

• Record Type: Journal Article
• Authors: Scannell, M; Burton, E; Kearney, P M
• Is Part Of: International journal of pharmacy practice. Volume 31(2023)Supplement 1
• Page Start: i39
• Page End: i40
• Publication Date: 2023-04-13
• Subjects: Pharmacy -- Practice -- Periodicals; 615.1
• DOI: 10.1093/ijpp/riad021.046
• Languages: English
• ISSNs: 0961-7671

Abstract

Abstract: Introduction: Prior approval for reimbursement is a cost containment policy, aimed at reducing demand (1). It has been used temporarily in the Irish Healthcare system to deal with the initial financial challenges posed by the shift in use towards the Direct Oral Anticoagulants (DOACs) (apixaban, rivaroxaban, edoxaban and dabigatran) from warfarin. Improved safety of DOACs use was a secondary aim of this policy. The use of prior approval policies is increasing in Ireland but studies assessing their effectiveness are limited. Aim: To examine the effect of removing the cost containment policy of prior approval for reimbursement of apixaban and rivaroxaban using a national pharmacy claims database. Methods: The Health Service Executive-Primary Care Reimbursement Service database in Ireland was used in this cross-sectional study. The prescribing frequencies and associated costs of the oral anticoagulants; ((OACs) apixaban, rivaroxaban, and warfarin) listed in the top 100 most frequently prescribed drugs on the Community Drug Schemes (CDS), between 2018 and 2021 were examined. Levothyroxine was used as a negative control to detect any external deviances in the prescribing data records. Interrupted time series Poisson regression was used to assess the impact of removing the approval requirement of apixaban in September 2019 followed by the other DOACs in November 2020. Results: The prescribing frequency of OACs increased by almost 20% during the study period. Figure1 shows the prescribing frequencies of apixaban, rivaroxaban, warfarin and levothyroxine on each of the three community drug schemes – General medical scheme (GMS), Drug payments scheme (DPS) and Long term illness scheme (LTI) during the study period.Timelines at September 2019 and November 2020 show the removal of prior approval for apixaban and all DOACs respectively. This study showed there were significant differences in the proportion of OACs prescribed among the CDS. A statistically significant decreased use of apixaban (<1%, p<0.05) occurred when prior approval was removed for all DOACs. Conclusion: The removal of prior approval for reimbursement of DOACs in Ireland had a minimal impact on the prescribing frequency trends of the OACs. Future use of these potentially useful policies by healthcare systems requires careful consideration of drug type, approval criteria and length of time the policy remains in place. References: 1. Moreno-Serra R. The impact of cost-containment policies on health expenditure 2014 Available from: https://www.oecd-ilibrary.org/content/paper/budget-13-5jxx2wl6lp9p