Case Studies: Inappropriate Medication Use

Problem:

A major pharmaceutical company was under pressure from its managed care customers because of increased costs associated with use of it’s Cox-2 Inhibitor. Expected reductions in concomitant Proton-Pump Inhibitor (PPI) utilization had not occurred, resulting in excessively high total therapy costs for arthritis patients.

Process:

Claims analysis showed a close association of PPI prescribing with COX-2 Inhibitor initiation. Additionally, patients on PPIs that switched from traditional NSAID therapy were continued on the PPI with no reevaluation of medical necessity.

Interviews revealed that physicians perceived that they only prescribed PPIs when they were clearly indicated (GERD, ulcer, etc.), and that there was no relationship between their COX-2 Inhibitor prescribing and utilization of PPIs.

Solutions:

Feedback – data were shown to outlier physicians illustrating the extent of overutilization of the PPIs with COX2 Inhibitor therapy.

Education – educational interventions were implemented to educate physicians on the appropriate utilization of COX-2 Inhibitors and PPI therapy.

Opportunities:

The process of a pharmaceutical company working together with a managed care plan produced a partnership which enabled both stakeholders to attain business goals. It also produced a model for future collaborative projects.