Anticholinergics have been used in the treatment of overactive bladder (OAB), but their use is limited by poor tolerability and anticholinergic-related side effects. Increasingly, providers are discontinuing anticholinergic prescribing because of growing evidence of the association of anticholinergic use with increased risk of cognitive decline and other adverse effects. Newer medications for OAB, the β3-adrenergic receptor agonists mirabegron and vibegron, do not have anticholinergic properties and are typically well tolerated; however, many insurance plans have limited patient access to these newer OAB medications by requiring step therapy, meaning less expensive anticholinergic medications must be trialed and/or failed before a β3-agonist will be covered and dispensed. Thus, many patients are unable to easily access these medications. Step therapy and other drug utilization strategies (e.g., prior authorization) are often used to manage the growing costs of pharmaceuticals, but these policies do not always follow treatment guidelines and may harm patients as a result of treatment delays, discontinuations, or related increases in adverse events. Medical professionals have called for reform of drug utilization strategies through partnerships that include clinicians and policymakers. This narrative review discusses prescribing patterns for OAB treatment and the effect of switching between drugs, as well as the costs of step therapy and prior authorization on patients and prescribers.
Advances in therapy. 2023 Sep 19 [Epub ahead of print]
Roger R Dmochowski, Diane K Newman, Eric S Rovner, Jacqueline Zillioux, Rena D Malik, A Lenore Ackerman
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA., Department of Urology, Medical University of South Carolina, Charleston, SC, USA., Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA., Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA., Departments of Urology and Obstetrics and Gynecology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, Box 951738, Los Angeles, CA, 90095-1738, USA. .