TY - JOUR
T1 - Evaluation of cost savings to a state medicaid program following a sertraline tablet-splitting program
AU - Vuchetich, Phillip J.
AU - Garis, Robert I.
AU - Jorgensen, Allison M.D.
N1 - Funding Information:
This study was supported, in part, by an unrestricted grant from Pfizer Inc. and a software grant from Microsoft Corporation. Vuchetich owns 15 shares of Pfizer Inc. stock (estimated value: $500). The other authors declare no conflicts of interest or financial interests in any product or service mentioned in the article, including grants, employment, gifts, stock holdings, or honoraria.
PY - 2003
Y1 - 2003
N2 - Objectives: To evaluate the economic impact of implementing a sertraline (Zoloft-Pfizer) tablet-splitting program on the Nebraska Medicaid program based on the change in total and per-member-per-month (PMPM) prescription drug costs and to identify any real or perceived problems with tablet splitting using switches among selective serotonin reuptake inhibitors (SSRIs) as a proxy indicator. Design: Retrospective study of prescription claims before and after the tablet-splitting program was implemented. Setting: Nebraska Medicaid. Patients: All 14,520 patients who received an SSRI during the study period, including 5,466 patients who received at least one prescription for sertraline. Interventions: The Nebraska Medicaid program implemented a mandatory tablet-splitting program for sertraline. Pharmacists were paid a supplemental fee to split tablets. Main Outcome Measures: Total costs, PMPM costs, and switches among SSRIs. Results: Using regression analysis, sertraline was the only SSRI that showed a downward slope in total cost per month, although the decrease was not statistically significant (P = .1156). Fluoxetine (Prozac - Eli Lilly) and paroxetine (Paxil - GlaxoSmithKline) both showed an upward slope, but the increases were not statistically significant (P = .1164 and .0671, respectively). Citalopram (Celexa-Forest) and fluvoxamine showed significantly positive upward slopes (P = .0001 and .0391, respectively). Sertraline was also the only SSRI that showed a downward slope in PMPM costs (P = .0093). Citalopram, fluvoxamine, fluoxetine, and paroxetine all showed an upward slope in PMPM costs (P = .4494, .0008, .0448, and .0482, respectively). The tablet-splitting program was not associated with a net change in patients being switched to or from sertraline. Conclusion: Implementing the sertraline tablet-splitting program significantly decreased the PMPM cost of sertraline prescriptions, but it did not significantly decrease total costs of sertraline, nor did it result in disproportionate numbers of patients switching from sertraline to other SSRIs. Total costs and PMPM costs of the other four SSRI drugs did not decrease.
AB - Objectives: To evaluate the economic impact of implementing a sertraline (Zoloft-Pfizer) tablet-splitting program on the Nebraska Medicaid program based on the change in total and per-member-per-month (PMPM) prescription drug costs and to identify any real or perceived problems with tablet splitting using switches among selective serotonin reuptake inhibitors (SSRIs) as a proxy indicator. Design: Retrospective study of prescription claims before and after the tablet-splitting program was implemented. Setting: Nebraska Medicaid. Patients: All 14,520 patients who received an SSRI during the study period, including 5,466 patients who received at least one prescription for sertraline. Interventions: The Nebraska Medicaid program implemented a mandatory tablet-splitting program for sertraline. Pharmacists were paid a supplemental fee to split tablets. Main Outcome Measures: Total costs, PMPM costs, and switches among SSRIs. Results: Using regression analysis, sertraline was the only SSRI that showed a downward slope in total cost per month, although the decrease was not statistically significant (P = .1156). Fluoxetine (Prozac - Eli Lilly) and paroxetine (Paxil - GlaxoSmithKline) both showed an upward slope, but the increases were not statistically significant (P = .1164 and .0671, respectively). Citalopram (Celexa-Forest) and fluvoxamine showed significantly positive upward slopes (P = .0001 and .0391, respectively). Sertraline was also the only SSRI that showed a downward slope in PMPM costs (P = .0093). Citalopram, fluvoxamine, fluoxetine, and paroxetine all showed an upward slope in PMPM costs (P = .4494, .0008, .0448, and .0482, respectively). The tablet-splitting program was not associated with a net change in patients being switched to or from sertraline. Conclusion: Implementing the sertraline tablet-splitting program significantly decreased the PMPM cost of sertraline prescriptions, but it did not significantly decrease total costs of sertraline, nor did it result in disproportionate numbers of patients switching from sertraline to other SSRIs. Total costs and PMPM costs of the other four SSRI drugs did not decrease.
KW - Citalopram
KW - Drug costs
KW - Fluoxetine
KW - Fluvoxamine
KW - Insurance claim review
KW - Paroxetine
KW - Pharmaceutical economics
KW - Prescription fees
KW - Retrospective studies
KW - Sertraline
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U2 - 10.1331/154434503322226248
DO - 10.1331/154434503322226248
M3 - Article
C2 - 12952314
AN - SCOPUS:0642335875
SN - 1544-3191
VL - 43
SP - 497
EP - 502
JO - Journal of the American Pharmacists Association
JF - Journal of the American Pharmacists Association
IS - 4
ER -