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Grant Details

Grant Number: 1R03CA270451-01A1 Interpret this number
Primary Investigator: Dillender, Marcus
Organization: Vanderbilt University
Project Title: Examining the Impact of Medicaid's Prior Authorization Requirements for Tobacco Cessation Medications on Tobacco Cessation Medication Prescriptions
Fiscal Year: 2023


PROJECT SUMMARY/ABSTRACT Increasing access to tobacco cessation medications is a key part of U.S. health policy’s strategy for reducing smoking, especially for low-income smokers, who are less likely to use tobacco cessation medications than high-income smokers are. Given that the Affordable Care Act requires Medicaid programs to cover tobacco cessation medications, Medicaid coverage grants enrollees access to tobacco cessation medications in principle, but over two-thirds of state Medicaid programs require doctors to obtain prior authorization from program administrators before prescribing tobacco cessation medications. While prior authorization requirements’ advocates argue that requiring prior authorization can ensure appropriate and cost-effective prescribing without reducing access to helpful medications, even small prescribing hurdles have the potential to have large impacts on prescribing behavior and medication access. Public health leaders call for removing barriers in access to tobacco cessation medications, but it is not currently known if requiring prior authorization meaningfully reduces overall use of these medications or if it instead ensures appropriate use without reducing access more generally, as its advocates argue. This project proposes to estimate the impact of prior authorization requirements in Medicaid on the use of tobacco cessation medications by using detailed data on health care claims to study Colorado’s Medicaid program removing its prior authorization requirement for tobacco cessation medications in 2018. A primary objective of the proposed project is to estimate the impact of Colorado removing its prior authorization requirement on overall tobacco cessation prescriptions and related treatments. A second objective is to estimate heterogeneous impacts of removing prior authorization requirements for different demographic groups. The project then proposes to use the estimates to conduct additional analyses to assess the national implications of Medicaid programs requiring prior authorization for tobacco cessation medications. In addition, the project proposes to test for heterogeneous effects of prior authorization requirements based on prior health conditions to assess the claim that the main effect of prior authorization requirements is to avoid prescriptions that Medicaid programs could identify as potentially being inappropriate. Achieving these aims will provide stakeholders with information that can be used when making decisions about whether to require prior authorization for tobacco cessation medications and, conditional on requiring prior authorization, to set up systems and rules that improve the prior authorization process for tobacco cessation medications. Achieving the aims of this study will address multiple research priorities of the National Cancer Institute by increasing knowledge about barriers in access to evidenced-based cessation treatments, by identifying strategies to increase the use of cessation treatments for people with low socioeconomic status, and by providing insights into how insurers can contribute to tobacco cessation.



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