MEDICAID PRIOR AUTHORIZATION AND OPIOID MEDICATION ABUSE AND OVERDOSE

Details

• Alternative Title:
  Am J Manag Care
• Personal Author:
  Cochran, Gerald ; Gordon, Adam J. ; Gellad, Walid F. ; Chang, Chung-Chou H. ; Lo-Ciganic, Wei-Hsuan ; Lobo, Carroline ; Cole, Evan ; Frazier, Winfred ; Zheng, Ping ; Kelley, David ; Donohue, Julie M.
• Description:
  Objectives:
  
  The US opioid medication epidemic has resulted in serious health consequences for patients. Formulary management tools adopted by payers, specifically prior authorization policies (PA), may lower rates of opioid medication abuse and overdose. We compared rates of opioid abuse and overdose among enrollees in plans that varied in their use of PA from High (required PA for 17–74 opioids), Low (required PA for 1 opioid), to No PA policies for opioid medications.
  
  Study Design:
  
  Retrospective cohort study of patients initiating opioid treatment in Pennsylvania Medicaid from 2010 to 2012.
  
  Methods:
  
  Generalized linear models with generalized estimating equations were employed to assess relationships between presence of PA policies and opioid medication abuse and overdose, as measured in Medicaid claims data, adjusting for demographics, comorbid health conditions, benzodiazepine/muscle relaxant use, and emergency department use.
  
  Results:
  
  The study cohort included 297,634 enrollees, with a total of 382,828 opioid treatment episodes. Compared to plans with no PA, enrollees in High PA (Adjusted Rate Ratio [ARR]=0.89, 95% CI=0.85–0.93, p<0.001) and Low PA plans (ARR=0.93, 95%CI=0.87–1.00, p=0.04) had lower rates of abuse. Enrollees in the Low PA plan had a lower rate of overdose than those within plans with No PA (ARR=0.75, 95% CI=0.59–0.95, p=0.02). High PA plan enrollees were also less likely than No PA enrollees to experience overdose, but this association was not statistically significant (ARR=0.88, 95% CI=0.76–1.02, p=0.08).
  
  Conclusions:
  
  Enrollees within Medicaid plans that utilize PA policies appear to have lower rates of abuse and overdose following initiation of opioid medication treatment.
  
  
• Subjects:
  Adolescent Adult Analgesics, Opioid Drug Overdose Female Humans Male Middle Aged Retrospective Studies Substance-Related Disorders Young Adult

  More +
• Source:
  Am J Manag Care. 23(5):e164-e171
• Pubmed ID:
  28810127
• Pubmed Central ID:
  PMC6719534
• Document Type:
  Journal Article
• Funding:
  U01 CE002496/CE/NCIPC CDC HHS/United States
• Place as Subject:
  Pennsylvania
• Volume:
  23
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:670cf3e214e4a8f9ab062facc9451a1a9432a6fdce9cb6a3caf7efb72795d46d
• Download URL:
  https://stacks.cdc.gov/view/cdc/81117/cdc_81117_DS1.pdf
• File Type:
  [PDF - 110.80 KB ]