Medical and Pharmacy Cost and Utilization Outcomes of a Quantity Limit on the 5-HT1 Agonists (Triptans) by a Managed Care Organization

OBJECTIVE: To determine the overall medical and pharmacy impact on utilization and costs following implementation of a quantity limit on the 5-HT1 agonists (triptans). DESIGN: Retrospective review of pharmacy and medical claims data six months before and after implementation of a quantity limit. SETTING: A managed care organization based in western Pennsylvania. PARTICIPANTS: Pooled data of more than 11,000 triptan users. INTERVENTIONS: A quantity limit was placed on the triptans, allowing coverage for maximum doses for four migraines per month. MAIN OUTCOMES MEASURES: Comparison of utilization and costs of triptans, prophylactic medications, and other analgesics before and after implementation of the quantity limit. Utilization and costs of medical claims for hospitalizations, emergency room (ER), primary care physician (PCP), and neurologist visits for triptan users were analyzed during the same time periods. RESULTS: The quantity limit resulted in an overall drug and medical cost savings of $420,754 during the six months after initiation of the program. The utilization and costs associated with the triptans and other analgesic medications decreased, while the percentage of patients taking prophylactic therapy increased. A small change in utilization and costs of hospitalizations, PCP visits, ER visits, and neurologist visits was noted. CONCLUSION: Implementation of a quantity limit on the triptans effectively changed the utilization of pharmacologic therapy for migraines with minimal shift in the utilization of other healthcare resources, resulting in an overall healthcare savings of $12.25 per patient per month (PPPM) for those triptan users.