Medicaid prior authorization and opioid medication abuse and overdose

Gerald Cochran, Adam J. Gordon, Walid F. Gellad, Chung Chou H. Chang, Wei Hsuan Lo-Ciganic, Carroline Lobo, Evan Cole, Winfred Frazier, Ping Zheng, David Kelley, Julie M. Donohue

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: The US opioid medication epidemic has resulted in serious health consequences for patients. Formulary management tools adopted by payers, specifically prior authorization (PA) policies, may lower the 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 PA" (ie, required PA for 17 to 74 opioids), with "Low PA" (ie, required PA for 1 opioid), and "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 the relationships between the 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 with plans with No PA, enrollees in High PA (adjusted rate ratio [ARR], 0.89; 95% confidence interval [CI], 0.85-0.93; P <.001) and Low PA plans (ARR, 0.93; 95% CI, 0.87-1.00; P = .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 = .02). High PA plan enrollees were also less likely than No PA enrollees to experience an overdose, but this association was not statistically significant (ARR, 0.88; 95% CI, 0.76-1.02; P = .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.

Original languageEnglish (US)
Pages (from-to)e164-e171
JournalThe American journal of managed care
Volume23
Issue number5
StatePublished - May 1 2017
Externally publishedYes

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Medicaid
Opioid Analgesics
Confidence Intervals
Cohort Studies
Formularies
Health
Benzodiazepines
Hospital Emergency Service
Linear Models
Therapeutics
Retrospective Studies
Demography
Muscles

ASJC Scopus subject areas

  • Health Policy

Cite this

Cochran, G., Gordon, A. J., Gellad, W. F., Chang, C. C. H., Lo-Ciganic, W. H., Lobo, C., ... Donohue, J. M. (2017). Medicaid prior authorization and opioid medication abuse and overdose. The American journal of managed care, 23(5), e164-e171.

Medicaid prior authorization and opioid medication abuse and overdose. / 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.

In: The American journal of managed care, Vol. 23, No. 5, 01.05.2017, p. e164-e171.

Research output: Contribution to journalArticle

Cochran, G, Gordon, AJ, Gellad, WF, Chang, CCH, Lo-Ciganic, WH, Lobo, C, Cole, E, Frazier, W, Zheng, P, Kelley, D & Donohue, JM 2017, 'Medicaid prior authorization and opioid medication abuse and overdose', The American journal of managed care, vol. 23, no. 5, pp. e164-e171.
Cochran G, Gordon AJ, Gellad WF, Chang CCH, Lo-Ciganic WH, Lobo C et al. Medicaid prior authorization and opioid medication abuse and overdose. The American journal of managed care. 2017 May 1;23(5):e164-e171.
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. / Medicaid prior authorization and opioid medication abuse and overdose. In: The American journal of managed care. 2017 ; Vol. 23, No. 5. pp. e164-e171.
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abstract = "OBJECTIVES: The US opioid medication epidemic has resulted in serious health consequences for patients. Formulary management tools adopted by payers, specifically prior authorization (PA) policies, may lower the 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 PA{"} (ie, required PA for 17 to 74 opioids), with {"}Low PA{"} (ie, required PA for 1 opioid), and {"}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 the relationships between the 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 with plans with No PA, enrollees in High PA (adjusted rate ratio [ARR], 0.89; 95{\%} confidence interval [CI], 0.85-0.93; P <.001) and Low PA plans (ARR, 0.93; 95{\%} CI, 0.87-1.00; P = .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 = .02). High PA plan enrollees were also less likely than No PA enrollees to experience an overdose, but this association was not statistically significant (ARR, 0.88; 95{\%} CI, 0.76-1.02; P = .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.",
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T1 - Medicaid prior authorization and opioid medication abuse and overdose

AU - Cochran, Gerald

AU - Gordon, Adam J.

AU - Gellad, Walid F.

AU - Chang, Chung Chou H.

AU - Lo-Ciganic, Wei Hsuan

AU - Lobo, Carroline

AU - Cole, Evan

AU - Frazier, Winfred

AU - Zheng, Ping

AU - Kelley, David

AU - Donohue, Julie M.

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N2 - OBJECTIVES: The US opioid medication epidemic has resulted in serious health consequences for patients. Formulary management tools adopted by payers, specifically prior authorization (PA) policies, may lower the 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 PA" (ie, required PA for 17 to 74 opioids), with "Low PA" (ie, required PA for 1 opioid), and "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 the relationships between the 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 with plans with No PA, enrollees in High PA (adjusted rate ratio [ARR], 0.89; 95% confidence interval [CI], 0.85-0.93; P <.001) and Low PA plans (ARR, 0.93; 95% CI, 0.87-1.00; P = .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 = .02). High PA plan enrollees were also less likely than No PA enrollees to experience an overdose, but this association was not statistically significant (ARR, 0.88; 95% CI, 0.76-1.02; P = .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.

AB - OBJECTIVES: The US opioid medication epidemic has resulted in serious health consequences for patients. Formulary management tools adopted by payers, specifically prior authorization (PA) policies, may lower the 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 PA" (ie, required PA for 17 to 74 opioids), with "Low PA" (ie, required PA for 1 opioid), and "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 the relationships between the 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 with plans with No PA, enrollees in High PA (adjusted rate ratio [ARR], 0.89; 95% confidence interval [CI], 0.85-0.93; P <.001) and Low PA plans (ARR, 0.93; 95% CI, 0.87-1.00; P = .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 = .02). High PA plan enrollees were also less likely than No PA enrollees to experience an overdose, but this association was not statistically significant (ARR, 0.88; 95% CI, 0.76-1.02; P = .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.

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