North Carolina Medicaid Recipient Management Lock-In Program: The Pharmacist’s Perspective

Details

• Alternative Title:
  J Manag Care Spec Pharm
• Personal Author:
  Werth, S. Rose ; Sachdeva, Nidhi ; Roberts, Andrew W. ; Garrettson, Mariana ; Ringwalt, Chris ; Moss, Leslie A. ; Pikoulas, Theodore ; Skinner, Asheley Cockrell
• Description:
  BACKGROUND
  
  The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.
  
  OBJECTIVES
  
  To (a) evaluate pharmacists’ perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.
  
  METHODS
  
  We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.
  
  RESULTS
  
  Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists’ part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists’ lack of knowledge about the program’s purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.
  
  CONCLUSIONS
  
  Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists’ medication gate-keeping role, while minimizing the effort required for successful implementation.
  
  
• Subjects:
  Anti-Anxiety Agents Attitude Of Health Personnel Drug And Narcotic Control Interviews As Topic Medicaid Opioid-Related Disorders Pharmacists Substance-Related Disorders
• Source:
  J Manag Care Spec Pharm. 20(11):1122-1129
• Pubmed ID:
  25351973
• Pubmed Central ID:
  PMC6833956
• Document Type:
  Journal Article
• Funding:
  UL1TR000083/TR/NCATS NIH HHSUnited States/ ; U01 CE002160-01/CE/NCIPC CDC HHSUnited States/ ; T32 NR008856/NR/NINR NIH HHSUnited States/ ; U01 CE002160/CE/NCIPC CDC HHSUnited States/ ; L30 DA042439/DA/NIDA NIH HHSUnited States/ ; UL1 TR000083/TR/NCATS NIH HHSUnited States/ ; T32 HS000032/HS/AHRQ HHSUnited States/ ; 5 T32 HS000032/HS/AHRQ HHSUnited States/ ; K12 HD001441/HD/NICHD NIH HHSUnited States/
• Place as Subject:
  North Carolina
• Volume:
  20
• Issue:
  11
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:094631f4b82384e67dd8869904941848550e887f500a7bd3201d82350273e6d0
• Download URL:
  https://stacks.cdc.gov/view/cdc/94474/cdc_94474_DS1.pdf
• File Type:
  [PDF - 85.40 KB ]