Overactive bladder treatment options

by Analisa Elliott, PharmD

Overactive bladder affects more than 30 million adults in the U.S. While the American Urological Association guidelines for non-neurogenic overactive bladder recommend non-pharmacologic first-line treatments (bladder training, fluid management and pelvic floor muscle training), these therapies can take weeks before any benefit is seen. Therefore, second-line therapy, such as oral anti-muscarinics and oral β3-adrenergic receptor agonists, can be combined with behavioral therapies to provide quicker relief.

The efficacy of these different agents is very similar, and due to the higher cost of the oral β3-adrenergic receptor agonists, CareOregon prefers lower-cost oral anti-muscarinics. Because ER agents tend to have fewer side effects, CareOregon Medicaid covers three different ER formulations. CareOregon Medicare covers Myrbetriq, but with step therapy after failure of two anti-muscarinics. Covered products are subject to prior authorization and quantity limits.

Overactive bladder benefit:

Medication

OHP (Medicaid)

COA (Medicare)

Oxybutynin IR & ER* tabs

Covered

Covered

Solifenacin tabs*

Covered

Covered

Tolterodine IR tabs & ER* caps

Covered with PA

(requires failure of oxybutynin or solifenacin)

Covered

Trospium IR tabs

Covered with PA

(requires failure of oxybutynin or solifenacin)

Covered

Trospium ER caps*

Not covered

Covered

Myrbetriq tabs

Not covered

Covered

Gemtesa tabs

Not covered

Not covered

*Once-daily agent.