Medical utilization and cost impact of significantly reducing proton pump inhibitor coverage: An actuarial analysis

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By Bruce S. Pyenson, Kathryn V. Fitch | 24 April 2011

Significantly restricting or dropping coverage for prescription drugs that have an over the counter (OTC) option can generate cost savings to payers. OTC drugs are considered safe and clinically effective, although some have raised concerns about their real-world effectiveness compared to prescription drugs. This report examines the frequency of sensitive medical conditions and services in the year before and after significant restriction or dropping of prescription benefit coverage of proton pump inhibitors to determine if there were adverse impacts on services or medical cost.

This paper was commissioned by Procter & Gamble, which markets an OTC PPI.