Effectiveness of risk management plans: a case study of pemoline using pharmacy claims data

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Abstract
Purpose: To assess the effectiveness of a pharmaceutical risk management plan using pemoline as a case study and pharmacy claims as the data source.Methods: Prescription claims from a continuously enrolled US population (September 1, 2000–September 30, 2002) from Caremark, a pharmacy benefit manager, were evaluated for patients with one or more pemoline claims. Patients were categorized using pemoline as second‐line or first‐line therapy depending on presence or absence of other central nervous system (CNS) stimulants prescriptions 90 days prior to the first pemoline claim. Logistic regression was performed to compare second‐line and first‐line usage with regard to patient age, gender and prescribing physician specialty and region of practice.Results: Of 1 279 296 prescription claims for CNS stimulants, 17 256 (1.3%) were for pemoline. Nine hundred thirteen patients received pemoline and had 90 days or more prior enrollment. Overall, 10% of patients receiving pemoline received it as second‐line therapy (95%CI: 8–12%). After adjusting for age, gender, specialty, and region, the odds of receiving pemoline as second‐line therapy were significantly greater in pediatrics relative to adults (OR = 2.82, 95%CI: 1.58–5.03), and among those whose prescribers were psychiatrists versus primary care physicians (OR = 2.48, 95%CI: 1.37–4.50). Children treated by a psychiatrist had the greatest likelihood for use as second‐line therapy (36%, 95%CI: 19–56%).Conclusions: Among patients who received pemoline, concordance with second‐line therapy recommendations was low, even among the primary target audience of children. These results in a large geographically diverse patient population are consistent with an earlier regional study. Copyright © 2006 John Wiley & Sons, Ltd.