Impact of Sequential Opioid Dose Reduction Interventions in a State Medicaid Program Between 2002 and 2017
Department of Medicine; Commonwealth Medicine, Clinical Pharmacy Services
Health Law and Policy | Health Policy | Health Services Administration | Health Services Research | Pharmacy Administration, Policy and Regulation | Substance Abuse and Addiction
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 1a and 1b), > 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 1a (P < .001), immediately after intervention 1b (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.
Medicaid, Opioid, epidemic, high dose, morphine equivalent dose, policy, prior authorization
DOI of Published Version
J Pain. 2019 Aug;20(8):876-884. doi: 10.1016/j.jpain.2019.01.008. Epub 2019 Jan 26. Link to article on publisher's site
The journal of pain: official journal of the American Pain Society
Garcia MM, Lenz KJ, Greenwood BC, Angelini MC, Thompson T, Clements KM, Mauro R, Jeffrey PL. (2019). Impact of Sequential Opioid Dose Reduction Interventions in a State Medicaid Program Between 2002 and 2017. Commonwealth Medicine Publications. https://doi.org/10.1016/j.jpain.2019.01.008. Retrieved from https://escholarship.umassmed.edu/commed_pubs/232