UNC Eshelman School of Pharmacy, Campus Box 7573, Kerr Hall 2206, 301 Pharmacy Ln., Chapel Hill, NC 27599.
J Manag Care Spec Pharm. 2014 May;20(5):439-46c. doi: 10.18553/jmcp.2014.20.5.439.
Nonmedical use of prescription medications--particularly controlled substances--has risen dramatically in recent decades, resulting in alarming increases in overdose-related health care utilization, costs, and mortality. The Centers for Disease Control and Prevention estimate that 80% of abused and misused controlled substances originate as legal prescriptions. As such, policymakers and payers have the opportunity to combat nonmedical use by regulating controlled substance accessibility within legal prescribing and dispensing processes. One common policy strategy is found in Medicaid controlled substance lock-in programs. Lock-in programs identify Medicaid beneficiaries exhibiting high-risk controlled substance seeking behavior and "lock in" these patients to, typically, a single prescriber and pharmacy from which they may obtain Medicaid-covered controlled substance prescriptions. Lock-in restrictions are intended to improve care coordination between providers, reduce nonmedical use behaviors, and limit Medicaid costs stemming from nonmedical use and diversion. Peer-reviewed and gray literature have been examined to assess the current prevalence and design of Medicaid lock-in programs, as well as the current evidence base for informing appropriate program design and understanding program effectiveness. Forty-six state Medicaid agencies currently operate lock-in programs. Program design varies widely between states in terms of defining high-risk controlled substance use, the scope of actual lock-in restrictions, and length of program enrollment. Additionally, there is a remarkable dearth of peer-reviewed literature evaluating the design and effectiveness of Medicaid lock-in programs. Nearly all outcomes evidence stemmed from publicly accessible internal Medicaid program evaluations, which largely investigated cost savings to the state. Lock-in programs are highly prevalent and poised to play a meaningful role in curbing the prescription drug abuse epidemic. However, achieving these ends requires a concerted effort from the academic and policy communities to rigorously evaluate the effect of lock-in programs on patient outcomes, determine optimal program design, and explore opportunities to enhance lock-in program impact through coordination with parallel controlled substance policy efforts, namely prescription drug-monitoring programs.
非医疗用途的处方药物 - 尤其是管制药物 - 在最近几十年急剧上升，导致与过量用药相关的医疗保健利用、成本和死亡率令人震惊地增加。疾病控制和预防中心估计，80%的滥用和误用管制药物起源于合法处方。因此，政策制定者和支付者有机会通过在合法处方和配药过程中控制管制药物的可及性来打击非医疗用途。一种常见的政策策略是在医疗补助管制物质锁定计划中找到。锁定计划确定表现出高风险管制物质寻求行为的医疗补助受益人，并“锁定”这些患者通常只能从他们可以获得医疗补助覆盖的管制物质处方的单一处方医生和药房获得药物。锁定限制旨在改善提供者之间的护理协调，减少非医疗用途行为，并限制因非医疗用途和转移而导致的医疗补助费用。审查了同行评议和灰色文献，以评估医疗补助锁定计划的当前流行率和设计，以及为告知适当的计划设计和了解计划效果提供信息的当前证据基础。目前，有 46 个州的医疗补助机构运营锁定计划。各州之间在界定高风险管制物质使用、实际锁定限制的范围和计划参与的时间长度方面，计划设计差异很大。此外，几乎没有评估医疗补助锁定计划设计和效果的同行评议文献。几乎所有的结果证据都来自公开的内部医疗补助计划评估，这些评估主要调查了对州的成本节约。锁定计划非常普遍，有可能在遏制处方药物滥用方面发挥重要作用。然而，要实现这些目标，需要学术界和政策界共同努力，严格评估锁定计划对患者结果的影响，确定最佳计划设计，并探索通过与平行管制药物政策努力（即处方药物监测计划）协调来增强锁定计划影响的机会。
