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Commercial and public payer opioid analgesic prescribing policies: a case study

BACKGROUND: One strategy to address the high number of U.S. opioid-related deaths is to restrict high-risk or inappropriate opioid analgesic prescribing and dispensing. Federal and state laws and regulations have implemented restrictions but less is known about commercial and public payers’ policies...

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Autores principales: Arfken, Cynthia L., Tutag Lehr, Victoria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789815/
https://www.ncbi.nlm.nih.gov/pubmed/33407646
http://dx.doi.org/10.1186/s13011-020-00340-z
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author Arfken, Cynthia L.
Tutag Lehr, Victoria
author_facet Arfken, Cynthia L.
Tutag Lehr, Victoria
author_sort Arfken, Cynthia L.
collection PubMed
description BACKGROUND: One strategy to address the high number of U.S. opioid-related deaths is to restrict high-risk or inappropriate opioid analgesic prescribing and dispensing. Federal and state laws and regulations have implemented restrictions but less is known about commercial and public payers’ policies aside from clinician anecdotal reports that these policies are increasing. To assess the number and types of policies with temporal trends, we examined commercial and public (Medicaid) payer policies in one state, Michigan, that has high opioid-related deaths and implemented opioid analgesic prescribing laws. METHODS: Policies for seven large commercial payers and the public payer for 2012–2018 were reviewed and categorized by actions. Joinpoint regression was used to summarize temporal trends on number of policies for all payers and subgroups. RESULTS: Across the 7 years, there were 529 action policies (75.57 (95% confidence intervals (CI) 35.93, 115.22) actions per year) with a range of 36 to 103 actions by payer. Limitations on number of days for initial prescriptions and prior authorizations were the most frequently implemented policy. The temporal trend showed a decline in new policies from 2012 to 2013 but a steady increase from 2014 to 2018 (average annual percent change or AAPC=29.6% (95% confidence intervals 13.2, 48.5%)). The public payer (n=47 policies) showed no increase in number of policies over time (AAPC=2.9% (95% CI -41.6, 61.6%). CONCLUSIONS: The eight commercial and public payers implemented many new policies to restrict opioid analgesic prescribing with a steady increase in the number of such policies implemented from 2014 to 2018. This case study documented that at least in one state with high opioid-related deaths and multiple commercial payers, new and different policies were increasingly implemented creating barriers to patient care. The impact of these policies is understudied, complicating recommendation of best practices.
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spelling pubmed-77898152021-01-11 Commercial and public payer opioid analgesic prescribing policies: a case study Arfken, Cynthia L. Tutag Lehr, Victoria Subst Abuse Treat Prev Policy Research BACKGROUND: One strategy to address the high number of U.S. opioid-related deaths is to restrict high-risk or inappropriate opioid analgesic prescribing and dispensing. Federal and state laws and regulations have implemented restrictions but less is known about commercial and public payers’ policies aside from clinician anecdotal reports that these policies are increasing. To assess the number and types of policies with temporal trends, we examined commercial and public (Medicaid) payer policies in one state, Michigan, that has high opioid-related deaths and implemented opioid analgesic prescribing laws. METHODS: Policies for seven large commercial payers and the public payer for 2012–2018 were reviewed and categorized by actions. Joinpoint regression was used to summarize temporal trends on number of policies for all payers and subgroups. RESULTS: Across the 7 years, there were 529 action policies (75.57 (95% confidence intervals (CI) 35.93, 115.22) actions per year) with a range of 36 to 103 actions by payer. Limitations on number of days for initial prescriptions and prior authorizations were the most frequently implemented policy. The temporal trend showed a decline in new policies from 2012 to 2013 but a steady increase from 2014 to 2018 (average annual percent change or AAPC=29.6% (95% confidence intervals 13.2, 48.5%)). The public payer (n=47 policies) showed no increase in number of policies over time (AAPC=2.9% (95% CI -41.6, 61.6%). CONCLUSIONS: The eight commercial and public payers implemented many new policies to restrict opioid analgesic prescribing with a steady increase in the number of such policies implemented from 2014 to 2018. This case study documented that at least in one state with high opioid-related deaths and multiple commercial payers, new and different policies were increasingly implemented creating barriers to patient care. The impact of these policies is understudied, complicating recommendation of best practices. BioMed Central 2021-01-06 /pmc/articles/PMC7789815/ /pubmed/33407646 http://dx.doi.org/10.1186/s13011-020-00340-z Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Arfken, Cynthia L.
Tutag Lehr, Victoria
Commercial and public payer opioid analgesic prescribing policies: a case study
title Commercial and public payer opioid analgesic prescribing policies: a case study
title_full Commercial and public payer opioid analgesic prescribing policies: a case study
title_fullStr Commercial and public payer opioid analgesic prescribing policies: a case study
title_full_unstemmed Commercial and public payer opioid analgesic prescribing policies: a case study
title_short Commercial and public payer opioid analgesic prescribing policies: a case study
title_sort commercial and public payer opioid analgesic prescribing policies: a case study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789815/
https://www.ncbi.nlm.nih.gov/pubmed/33407646
http://dx.doi.org/10.1186/s13011-020-00340-z
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