Pharmaceuticals represent a rapidly growing area of health care expenditures. These rising costs have led many payers to implement prior authorization as one type of cost control policy. Prior authorization is most effective in drug classes with high substitutability. However, for certain conditions, like mental health disorders, drugs are not always readily substitutable. In a HCFO-funded study, Christine Y. Lu, Ph.D., Stephen B. Soumerai, Sc.D., and colleagues examined the impact of a prior authorization policy implemented in the Maine Medicaid program and its effect on the medication adherence and health services use among bipolar patients with varying degrees of disease severity.
