(66) Analysis on the net costs of administering a prior authorization policy for onabotulinumtoxinA in the chronic migraine population

Background: : Prior authorizations (PAs) are a common utilization management technique meant to ensure the proper usage of certain medication per clinical treatment guidelines and/or approved indications. While cost containment may be another goal of PAs, the cost of administering and reviewing PAs must also be considered.

Objective: : To understand the annual net financial impact of administering a PA policy for onabotulinumtoxinA (onabotA) in the chronic migraine (CM) population.

Methods: : A cost calculator was constructed from the perspective of a hypothetical large national health plan of 10 million members using Microsoft Excel. First the administration costs were calculated by multiplying the expected annual onabotA CM patient volume by the cost of reviewing each PA, renewal, and appeal, which was set at $80 per review and sourced from survey research data. Renewals were assumed to be required every 6 months. These costs were then compared to the annual cost-savings from the PA policy, which were calculated by the cost of onabotA therapy averted based on PA and renewal approval rates (91.2% and 98.1% respectively). Approval rates were sourced from open healthcare claims data in PurpleLab®. Cost-savings were then subtracted from administration costs to calculate the net financial impact of the PA policy.

Results: : In a hypothetical health plan of 10 million members, there was a total of approximately 8000 expected users of onabotA for CM. The annual net financial impact of administering the PA policy was approximately -$366,000, indicating a net loss to the health plan. It is important to note that this result is only when considering the CM indication, while onabotA has multiple approved indications for which a PA policy may be in place.

Conclusions: : The cost of administering a prior authorization policy for onabotA in the CM population exceeds the cost-savings from the policy.

Sponsorship:: AbbVie Inc.