Preferred drug utilization: Treating allergic rhinitis with less-sedating antihistamines

Background: In 2005, Arkansas Medicaid initiated an evidence-based prescription drug program. Loratadine was selected as the preferred less-sedating antihistamine (LSA). Objectives: To examine the impact of using a preferred LSA for treatment of allergic rhinitis (AR) among children enrolled in Medic-aid and the State Children's Health Insurance Program. Methods: LSA claims data for children (aged 2-17 years) diag-nosed with AR alone were retrospectively extracted for 12 months before and after program implementation. Changes in pharmacy claims, healthcare utilization, and costs were analyzed. Results: We identified 11,591 children with AR. After program imple-mentation, loratadine claims increased (479 to 14,448; P <.001), while total LSA claims decreased (19,111 to 15,699; P <.001). A significant increase was seen in claims for leukotriene modifier (2341 to 3289; P <.001) and intranasal steroids (4614 to 5064; P <.001). There were significantly fewer outpatient claims (49,824 to 43,162; P <.001) and emergency department claims (3886 to 3236; P <.001). LSA pharmacy costs for children with AR decreased ($993,410 to $268,853; P <.001). Prior authorization for a nonpre-ferred LSA was requested for only 3% of the patients. Conclusions: Implementation of a preferred drug program for LSA using loratadine resulted in a change in filling patterns and LSA and medical cost reduction, without evidence of increased healthcare utilization. No significant change in overall pharmacy spending was observed, and a shift was seen in utilization of other therapies to treat AR.