Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, 4201 St Antoine St, UHC 5E, Detroit, MI, 48201, USA.
J Gen Intern Med. 2022 Nov;37(14):3630-3637. doi: 10.1007/s11606-021-07314-2. Epub 2022 Jan 11.
Between August 2016 and July 2018, three states classified gabapentin as a Schedule V drug and nine states implemented prescription drug monitoring program (PDMP) regulation for gabapentin. It is highly unusual for states to take drug regulation into their own hands. The impact of these changes on gabapentin prescribing is unclear.
To determine the effect of state-imposed regulation on gabapentin prescribing for Medicare Part D enrollees from 2013 to 2018.
Population-based difference-in-difference(DID) analysis study utilizing the Medicare Part D Prescriber Public Use File.
All eligible Medicare Part D prescribers excluding those outside of the fifty states and the District of Columbia were included in our analysis. Prescriber data and key sociodemographic variables were organized by state and year. States with a gabapentin schedule change or PDMP regulation enacted before 2019 were included in the intervention group. For the Schedule V DID analysis, a control group of the ten highest opioid-prescribing states was used.
States with gabapentin schedule changes or PDMP regulation before January 1, 2019, were included and compared to control states that did not implement these policies.
Total days' supply of gabapentin per enrollee per year was the primary outcome variable.
The mean total days' supply of gabapentin per enrollee increased 41% from 19.71 to 27.81 total days' supply per enrollee per year between 2013 and 2018. After adjustment, Schedule V gabapentin regulation resulted in a reduction of 8.37 total days of gabapentin prescribed per enrollee (95% confidence interval of - 10.34 to - 6.39). In contrast, PDMP regulation resulted in a reduction of 1.01 total days of gabapentin prescribed per enrollee (95% confidence interval of - 1.74 to - 0.29).
Classifying gabapentin as a Schedule V drug results in substantial reduction in total days prescribed whereas PDMP regulation results in modest reduction.
2016 年 8 月至 2018 年 7 月，有三个州将加巴喷丁列为附表 V 药物，有九个州对加巴喷丁实施了处方药监测计划 (PDMP) 监管。各州自行进行药物监管的情况极为罕见。这些变化对加巴喷丁处方的影响尚不清楚。
确定 2013 年至 2018 年期间州实施监管对医疗保险部分 D 参保者开处加巴喷丁的影响。
利用医疗保险部分 D 处方医生公共使用文件进行基于人群的差异（DID）分析研究。
除不在五十个州和哥伦比亚特区的参保者之外，所有符合条件的医疗保险部分 D 处方医生均被纳入本分析。按州和年份对处方医生数据和关键社会人口统计学变量进行了组织。将在 2019 年之前实施加巴喷丁时间表变更或 PDMP 监管的州纳入干预组。对于附表 V DID 分析，使用了十个开处阿片类药物最多的州作为对照组。
纳入并比较了在 2019 年 1 月 1 日之前实施加巴喷丁时间表变更或 PDMP 监管的州与未实施这些政策的对照组。
参保者每年每人的加巴喷丁总供应天数是主要观察指标。
2013 年至 2018 年间，参保者每人每年的加巴喷丁总供应天数从 19.71 天增加到 27.81 天，增加了 41%。调整后，附表 V 加巴喷丁监管使每位参保者的加巴喷丁处方总天数减少了 8.37 天（95%置信区间为-10.34 至-6.39）。相比之下，PDMP 监管使每位参保者的加巴喷丁处方总天数减少了 1.01 天（95%置信区间为-1.74 至-0.29）。
将加巴喷丁列为附表 V 药物可大幅减少处方总天数，而 PDMP 监管则可适度减少处方总天数。
