University of Michigan, Ann Arbor, 2929 Plymouth Rd., Ste. 245, Ann Arbor, MI 48105.
J Manag Care Spec Pharm. 2015 Nov;21(11):1006-12. doi: 10.18553/jmcp.2015.21.11.1006.
Prescription drug abuse is a growing epidemic in the United States, and opioids are among the most commonly abused and misused controlled substances. Managed care organizations can use pharmacy lock-in programs to limit patients' access to opioids by requiring that they receive all scripts from 1 prescriber, potentially reducing inappropriate use.
To evaluate opioid use patterns among patients in a Medicaid managed care lock-in program limiting opioid coverage to prescriptions written by assigned prescribers.
This retrospective cohort study included all patients enrolled in the lock-in program at Blue Care Network (BCN) of Michigan Medicaid managed care from March 2008 through May 2013, with outcomes assessed through August 2013. BCN medical and pharmacy claims, the Michigan Automated Prescription System, and Blue Cross Complete Controlled Substance Committee reports were used to assess outcomes at 6, 12, 24, and 36 months after enrollment. Patients were defined as "stable" if they exclusively filled opioid prescriptions from assigned prescribers or received treatment for opioid dependence and "unstable" if they purchased prescription opioids with cash or submitted opioid claims not prescribed by assigned providers.
Of the 59 patients enrolled in the program, over half (55.9%) dropped BCN coverage, and 1 died while enrolled. The proportion of patients who dropped coverage fell as time in the program increased, from 29% in the first 6 months to 11% semiannually after 24 months. Among those who remained enrolled, the proportion of stable patients increased from 31% at 6 months to 78% at 36 months. The small sample size did not permit formal statistical analysis.
The finding that most patients exited the program by dropping coverage was an unintended consequence meriting further investigation. Conversely, the finding that patients who remained enrolled largely achieved desired outcomes indicates that this program played an important role in addressing opioid abuse.
处方药物滥用在美国是一个日益严重的问题,阿片类药物是最常被滥用和误用的受控物质之一。管理式医疗保健组织可以通过实施药房锁定计划来限制患者获得阿片类药物的途径,即要求他们只能从指定的医生那里获得所有处方,从而潜在地减少不适当的使用。
评估参与密歇根州医疗补助管理式医疗保健锁定计划的患者的阿片类药物使用模式,该计划将阿片类药物的覆盖范围限制在指定医生开具的处方范围内。
这是一项回顾性队列研究,纳入了 2008 年 3 月至 2013 年 5 月期间参与密歇根州蓝十字健保网络(BCN)医疗补助管理式医疗保健锁定计划的所有患者,结局评估截至 2013 年 8 月。使用 BCN 的医疗和药房理赔、密歇根州自动处方系统以及蓝十字完整受控物质委员会报告来评估入组后 6、12、24 和 36 个月的结局。如果患者只从指定医生那里开阿片类药物处方或接受阿片类药物依赖治疗,则定义为“稳定”;如果患者用现金购买处方阿片类药物或提交非指定医生开具的阿片类药物处方,则定义为“不稳定”。
在参与该计划的 59 名患者中,超过一半(55.9%)退出了 BCN 保险,1 人在入组期间死亡。随着计划时间的增加,退出计划的患者比例下降,前 6 个月为 29%,24 个月后每半年为 11%。在继续入组的患者中,稳定患者的比例从 6 个月时的 31%增加到 36 个月时的 78%。由于样本量小,无法进行正式的统计学分析。
大多数患者通过退出保险来退出该计划是一个意外的后果,值得进一步调查。相反,大多数继续入组的患者基本上实现了预期的结果,这表明该计划在解决阿片类药物滥用方面发挥了重要作用。