Impact of Sequential Opioid Dose Reduction Interventions in a State Medicaid Program Between 2002 and 2017

JOURNAL OF PAIN

卷:20

Article

Garcia, Maria M.¹  Lenz, Kimberly²  Greenwood, Bonnie C.²  Angelini, Michael C.³  Thompson, Tyson^2,4  Clements, Karen M.²  Mauro, Rose P.²  Jeffrey, Paul L.² 

[1] Univ Massachusetts, Med Sch, Dept Med, Worcester, MA 01655 USA

[2] Univ Massachusetts, Med Sch, Commonwealth Med, Worcester, MA 01655 USA

[3] MCPHS Univ, Dept Pharm Practice, Boston, MA USA

[4] Pfizer Inc, 235 East 42nd St, New York, NY 10017 USA

关键词: Opioid;    morphine equivalent dose;    high dose;    prior authorization;    Medicaid;    epidemic;    policy;   

DOI  :  10.1016/j.jpain.2019.01.008

来源: Elsevier

【 摘 要 】

Policies that address opioid dose limits may help to decrease high-risk opioid prescribing. We evaluated 3 sequential and progressive decreases in high-dose (HD) opioid limits implemented by Massachusetts Medicaid over 15 years. The study population included members ages 18 to 64 years with >= 1 claim for a schedule II opioid between January 2002 and March 2017. The 3 interventions consisted of prior authorization requirements for prescriptions exceeding the morphine equivalent dose (MED) HD dose limits: >360 mg (intervention la and lb), >240 mg (intervention 2), and >120 mg (intervention 3). A segmented regression evaluated the change in natural log of the average daily MED (AD_MED). The natural log of the AD_MED decreased during the 6 quarters after intervention la (P <.001), immediately after intervention lb (P=.0002), and continued to decrease over the following 8 quarters (P =.023). The natural log of the AD_MED decreased immediately after intervention 2 (P =.002) and again after intervention 3 (P <.001). The percentage of users exceeding the HD limits of 360 mg, 240 mg, and 120 mg MED decreased by 87.3%, 79.8%, and 75.2% from baseline, respectively. The natural log of the AD_MED decreased among members after implementation of 3 sequential and progressive HD prior authorization limits, as did the percentage of members exceeding each of the HD limits. Perspective: This study demonstrates the longitudinal impact of a prior authorization policy-based HD limit in a Medicaid population. This study contributes to options for policymakers and other Medicaid programs as a potential strategy to assist in addressing the opioid epidemic. (C) 2019 by the American Pain Society

【 授权许可】

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