Impact of access restrictions on varenicline utilization

Abstract

Aim: To assess the impact of access restrictions on varenicline utilization. Methods: Employer-sponsored health plans contributing to the MarketScan Commercial Claims and Encounters Database were categorized according to 2009 varenicline access restrictions: no coverage; prior authorization; smoking cessation program requirement; no restrictions. The cohort comprised all adults continuously enrolled in plans during 2009. Each restriction cohort was compared with the no restrictions cohort using descriptive analyses. Data were assessed using logistic regression; demographic and clinical characteristics were covariates. Results: In this study (no coverage, n = 454,419; prior authorization, n = 171,530; smoking cessation program, n = 108,181; no restrictions, n = 607,389), compared with the no restrictions cohort, the odds of treatment were 71% lower (odds ratio: 0.29; 95% CI: 0.26, 0.31) in the smoking cessation program cohort (p < 0.001) and 80% lower (odds ratio: 0.20; 95% CI: 0.19, 0.22) in the prior authorization cohort (p < 0.001). Conclusions: Access restrictions were associated with significantly lower odds for varenicline utilization.

Keywords::

• access restriction
• nicotine replacement therapy
• smoking cessation
• utlization
• varenicline

Financial & competing interests disclosure

A Galaznik, G Makinson and KH Zou are employees of and shareholders in Pfizer, Inc. L Montejano, K Cappell and G Lenhart are employees of Truven Health Analytics, which received funding from Pfizer, Inc for the conduct of this study (data were analyzed by employees of Truven Health Analytics). Editorial/medical writing support was provided by H Jones at Engage Scientific, and was funded by Pfizer, Inc.

Key issues

• • Tobacco use is the leading cause of preventable death and disease in the USA.

• • Several effective smoking cessation pharmacotherapies are available and it is well established that smokers who use smoking cessation pharmacotherapies are two- to three-times more likely to quit compared with those who receive no treatment.

• • Despite the known benefits of smoking cessation, employers and third-party payers often do not provide insurance coverage for smoking cessation medications, and even when coverage is provided, use is reportedly low.

• • Lack of benefit uptake may be partly due to drug utilization management techniques.

• • This study assessed the impact of access restrictions (prior authorization required for coverage, participation in a smoking cessation program required for coverage, no coverage restrictions) on varenicline utilization.

• • The results suggest that access restrictions may be a deterrent to obtaining varenicline treatment.

• • Compared with those who had no restrictions on obtaining varenicline, individuals who were required to attend a smoking cessation program were 71% (p < 0.001) less likely to use varenicline, and those who were required to obtain prior authorization were 80% (p < 0.001) less likely to use varenicline.

• • Policy makers should review whether application of restrictions that may decrease utilization of a drug is beneficial.