In the OCT 18 issue of " pain medicine news" a free magazine .
OCTOBER 18, 2018
Disability Presents Significant Barrier to Nonopioid Treatment
Vancouver, British Columbia—Patients with disabilities who require nonopioid pain medications appear to face increased barriers to medically necessary pain treatments, according to a Chicago-based research team. Their analysis revealed that with the exception of tricyclic antidepressants, all nonopioid pain drugs had quantity restrictions and were more likely to need prior authorization compared with opioid medications.
“We had a patient with a spinal cord injury who asked why he could get Norco [hydrocodone and acetaminophen, Astellas] without a problem, but had a difficult time getting Vesicare [solifenacin succinate, Astellas], a medication he uses for management of a neurogenic bladder,” said Allison Glinka Przybysz, MD, MPH, a resident at the University of Chicago’s Schwab Rehabilitation Hospital and Care Network. “So, that got us wondering if there are differences in the access that patients with disabilities [spinal cord injuries, post-stroke pain, phantom pain and neuropathies] have to different types of medication, specifically with respect to pain medications.”
To answer this question, ( it is pretty simple narco 30 tabs cost 15$ vesicare 30 tab cost 380$, does this need a big study ?)the researchers conducted a cross-sectional review of 2017 registry data from the Centers for Medicare & Medicaid Services, Medicare Part D for prescription drug plan formularies in Illinois. They examined first-line pharmacologic pain therapies for common rehabilitation diagnoses. “We analyzed three specific variables: tier level or associated cost per patient, prior authorizations and quantitative restrictions,” Dr. Glinka Przybysz explained. “We used these as a proxy for access to medications.”
Presenting the study at the 2018 annual meeting of the American Academy of Pain Medicine (abstract 287), the investigators said quantity restrictions on gabapentin and pregabalin were present 47% and 76% of the time, respectively, across all drug plans. Tricyclic antidepressants were 2.5 times more likely to require prior authorization (P>0.05) and transdermal lidocaine products were 33 times more likely to require prior authorization, compared with opioid pain medications (P<0 .05="" font="">
No differences were found among tricyclic antidepressant, gabapentinoid and opioid tier levels. In contrast, tier levels for lidocaine products were significantly greater compared with opioid tier level (P<0 .05="" font="">
The researchers concluded that patients with disabilities requiring nonopioid pain medications may face barriers to medically necessary pain treatments. “Nonopioid pain medications other than tricyclic antidepressants had quantity restrictions and were more likely to require prior authorizations,” Dr. Glinka Przybysz said. “What’s more, these patients may face other barriers in obtaining nonopioid pain medications, such as increased cost.
“And while we’re still working on the ‘why’ part of it, our data do indicate that these differences may, in fact, exist,” Dr. Glinka Przybysz noted. “And they may create increased barriers to obtaining necessary treatment for patients with disabilities.”
Vancouver, British Columbia—Patients with disabilities who require nonopioid pain medications appear to face increased barriers to medically necessary pain treatments, according to a Chicago-based research team. Their analysis revealed that with the exception of tricyclic antidepressants, all nonopioid pain drugs had quantity restrictions and were more likely to need prior authorization compared with opioid medications.
“We had a patient with a spinal cord injury who asked why he could get Norco [hydrocodone and acetaminophen, Astellas] without a problem, but had a difficult time getting Vesicare [solifenacin succinate, Astellas], a medication he uses for management of a neurogenic bladder,” said Allison Glinka Przybysz, MD, MPH, a resident at the University of Chicago’s Schwab Rehabilitation Hospital and Care Network. “So, that got us wondering if there are differences in the access that patients with disabilities [spinal cord injuries, post-stroke pain, phantom pain and neuropathies] have to different types of medication, specifically with respect to pain medications.”
To answer this question, ( it is pretty simple narco 30 tabs cost 15$ vesicare 30 tab cost 380$, does this need a big study ?)the researchers conducted a cross-sectional review of 2017 registry data from the Centers for Medicare & Medicaid Services, Medicare Part D for prescription drug plan formularies in Illinois. They examined first-line pharmacologic pain therapies for common rehabilitation diagnoses. “We analyzed three specific variables: tier level or associated cost per patient, prior authorizations and quantitative restrictions,” Dr. Glinka Przybysz explained. “We used these as a proxy for access to medications.”
Presenting the study at the 2018 annual meeting of the American Academy of Pain Medicine (abstract 287), the investigators said quantity restrictions on gabapentin and pregabalin were present 47% and 76% of the time, respectively, across all drug plans. Tricyclic antidepressants were 2.5 times more likely to require prior authorization (P>0.05) and transdermal lidocaine products were 33 times more likely to require prior authorization, compared with opioid pain medications (P<0 .05="" font="">
No differences were found among tricyclic antidepressant, gabapentinoid and opioid tier levels. In contrast, tier levels for lidocaine products were significantly greater compared with opioid tier level (P<0 .05="" font="">
The researchers concluded that patients with disabilities requiring nonopioid pain medications may face barriers to medically necessary pain treatments. “Nonopioid pain medications other than tricyclic antidepressants had quantity restrictions and were more likely to require prior authorizations,” Dr. Glinka Przybysz said. “What’s more, these patients may face other barriers in obtaining nonopioid pain medications, such as increased cost.
“And while we’re still working on the ‘why’ part of it, our data do indicate that these differences may, in fact, exist,” Dr. Glinka Przybysz noted. “And they may create increased barriers to obtaining necessary treatment for patients with disabilities.”
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