Abstract:
BACKGROUND:The misuse of prescription drugs is a serious public health problem. Although controlled substance (CS) prescribing, in particular, opioid analgesics, has recently declined, the volume of prescriptions in 2015 was still 3 times higher than in 1999. To curb the high volume of CS prescribing, a national health plan has implemented a controlled substance utilization management (CSUM) program, a prescriber-focused educational intervention regarding patients at risk for CS misuse. OBJECTIVE:To characterize the effect of the CSUM program on CS prescribing volumes, number of prescribers and other health outcomes (opioid overdoses, all-cause emergency department visits, and all-cause hospitalizations). METHODS:The CSUM program identified patients who received ≥10 CS prescriptions within any 3-month window for noncancer pain as being high risk for CS misuse and mailed patient medication profiles to their CS prescribers. This retrospective study was conducted on patients whose prescribers were contacted by the CSUM program from January 2014 to December 2015. The reference group included patients with carved-out pharmacy benefits who were 1:1 propensity score matched to the program group. CS prescribing volumes, number of CS prescribers, and other health care utilization measures were assessed in the 6-month pre-intervention (baseline) period and 6-month post-intervention (follow-up) period using difference-in-difference (DID) analysis. RESULTS:After matching, each group had 17,295 patients, and there were no differences in baseline demographic and clinical characteristics. During the follow-up period, the CSUM group had 1.1 fewer prescriptions for CS (mean difference [MD] within group -3.2 vs. -2.1 prescriptions), 21 fewer days of supply (MD -27 vs. -6 days), and 0.2 fewer number of CS prescribers (MD -0.8 vs. -0.6 prescribers) per patient when compared with the reference group; all P values were < 0.001. The reductions in CS prescribing volumes and number of prescribers within the CSUM group were mainly driven by opioid analgesics, with minimal differences in benzodiazepines and stimulants between the 2 groups. The CSUM program had no significant effect on the opioid dosage strength but was associated with a lower rate of all-cause emergency department visits. CONCLUSIONS:The CSUM program had a moderate positive effect on reducing CS prescribing volumes and number of CS prescribers compared with a reference group. Beside the focus on patients who have already received 10+ CS prescriptions, there remains a need for more intensive approaches for accelerating targeted declines in CS in general and opioids in particular. DISCLOSURES:Funding for this study was provided by Anthem, which had no role in study design, data interpretation, manuscript development, or the decision to publish. Chen, Ma, Barron, DeVries, and Agiro are employees of HealthCore, a wholly owned subsidiary of Anthem. Horn is an employee of Anthem.
journal_name
J Manag Care Spec Pharmjournal_title
Journal of managed care & specialty pharmacyauthors
Chen X,Ma Q,Barron J,DeVries A,Horn J,Agiro Adoi
10.18553/jmcp.2019.25.3.392subject
Has Abstractpub_date
2019-03-01 00:00:00pages
392-401issue
3eissn
2376-0540issn
2376-1032journal_volume
25pub_type
杂志文章abstract:BACKGROUND:Medication therapy management (MTM) programs were first introduced as a result of the 2003 Medicare Prescription Drug Improvement and Modernization Act. Since then, the Centers for Medicare & Medicaid Services (CMS) have established minimum requirements for health plans to follow in establishing patient elig...
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journal_title:Journal of managed care & specialty pharmacy
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doi:10.18553/jmcp.2016.14251
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journal_title:Journal of managed care & specialty pharmacy
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
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更新日期:2020-06-01 00:00:00
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pub_type: 共识发展会议,杂志文章
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journal_title:Journal of managed care & specialty pharmacy
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journal_title:Journal of managed care & specialty pharmacy
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pub_type: 杂志文章
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journal_title:Journal of managed care & specialty pharmacy
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journal_title:Journal of managed care & specialty pharmacy
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 信件
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更新日期:2020-12-01 00:00:00
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
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journal_title:Journal of managed care & specialty pharmacy
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journal_title:Journal of managed care & specialty pharmacy
pub_type: 杂志文章
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pub_type: 杂志文章
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