Effects of a polypharmacy edit and reduced quantity limits on the utilization of triptans and overall costs in an...

On January 1, 2004, Intermountain Healthcare Health Plans implemented a polypharmacy edit and reduced the quantity limits of triptans to minimize the risks associated with triptan polypharmacy. The intervention covered one oral triptan brand per month and allowed one alternate formulation, limited monthly oral triptan quantities, and recommended use of prophylactic medication. During 2003, the prescription count per quarter for triptans increased from 4,816 to 5,359. The number of utilizing members increased from 2,659 to 2,781 over the course of the year. Total ingredient cost for fourth-quarter 2003 was dollar 932,950. For first-quarter 2004, the prescription count was 4,131 (used by 2,423 members) at a total ingredient cost of dollar 583,988. Fourth-quarter 2004 utilization was 4,763 prescriptions, 2,719 members, and dollar 700,534 total ingredient cost. The total triptan spend was dollar 872,718 lower during 2004 compared with 2003. Total medical claims remained constant over the two-year period for members who had a history of at least one triptan during that time. Educating members and health care professionals about the appropriate use of triptans can improve outcomes, and reevaluation of polypharmacy edits and quantity limits based on evolving clinical data improves the appropriate use of triptans.