Prior Authorization, Quantity Limits, and Step Therapy for Patient-Administered Antiemetics.

ABSTRACT:

Importance

Antiemetics have level 1 evidence supporting their role in improving quality of life and treatment tolerability for patients with cancer; they are an essential part of quality care. Utilization management (prior authorization, step therapy, and quantity limits) is implemented by insurance companies to improve effectiveness and efficiency and to control costs.

Objective

To characterize utilization management policies for antiemetics for Patient Protection and Affordable Care Act (ACA) Marketplace and Medicaid plans.

Design, setting, and participants

This cross-sectional study used a national sample of all available Medicaid and ACA drug formularies in 2024 linked to the US Food and Drug Administration's National Drug Codes. Formulations of the 13 most common

SUBMITTER: Vu K 

PROVIDER: S-EPMC12501812 | biostudies-literature | 2025 Oct

REPOSITORIES: biostudies-literature