Association between insurance cost-sharing subsidy and postoperative opioid prescription refills among Medicare patients

Kirsch, Michael J.; Montgomery, John R.; Hu, Hsou Mei; Englesbe, Michael J.; Brummett, Chad M.; Fendrick, A. Mark; Waljee, Jennifer F.

doi:10.1016/j.surg.2020.04.013

Cited by 6 publications

(4 citation statements)

References 42 publications

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“…Full cost sharing of opioid medication received by low-income patients has an impact on opioid refilling habits compared to patients receiving partial subsidies (25), These results are consistent with previous findings showing that decreased cost sharing was associated with increased drug replenishment (14).…”

Section: Pharmacysupporting

confidence: 90%

“…Based on the 8 articles reviewed, it was found that insurance financing schemes can affect the demand and supply of drugs. Low premium insurance and subsidies for full health coverage will increase demand for medicines (8,14). Health insurance financing by implementing cost sharing or co-payment will reduce the demand or need for drugs, because patients have to pay for part of the total health financing themselves (5,12,13,(15)(16)(17).…”

Section: Pharmacymentioning

confidence: 99%

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Insurance, Policy, Knowledge Level and Epidemiology As Factors Affecting Demand And Supply of Pharmaceutical Product

Cahaya

Pramestutie²,

Hati³

et al. 2022

PJI

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Fulfillment of drug availability is always a challenge from year to year and is determined by supply and demand issues for pharmaceutical drugs. Good management of drugs and pharmaceutical supplies is important in health services. This is related to the quality of health services and the efficiency and effectiveness of the budget. This review study aims to examine the factors that influence drug supply and demand simultaneously with a different perspective from other studies, namely, the focus is to simultaneously discuss the effects of health insurance financing schemes, registration regulations for pharmaceutical products and imports of pharmaceutical products, the level of pharmacist knowledge, changes in disease patterns, disasters, and wars on drug supply and demand. The research design that was used in this study is a narrative review. The data sources that were used are PubMed, Science Direct, Scopus, and Google Scholar. The inclusion criteria in this study are all research related to the demand for pharmaceutical supplies and drugsthat will be reviewed in the study, either in the form of original research, reviews, or reports. The results obtained articles consisting of 8 articles related to health insurance financing, 6 articles related to registration regulation of pharmaceutical products and import of pharmaceutical products, 5 articles related to pharmacist knowledge level, 3 articles related to changes in disease patterns, and 3 articles related to disasters and wars. Based on the 25 articles that were used as data in this study, it was found that the factors that influence the supply and demand of pharmaceutical supplies are health insurance financing, regulation of registration drug processes and imports of pharmaceutical products, level of knowledge of pharmacists as pharmaceutical service providers, changes in disease patterns, disasters, politics, and war.

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Section: Pharmacysupporting

confidence: 90%

Section: Pharmacymentioning

confidence: 99%

Insurance, Policy, Knowledge Level and Epidemiology As Factors Affecting Demand And Supply of Pharmaceutical Product

Cahaya

Pramestutie²,

Hati³

et al. 2022

PJI

View full text Add to dashboard Cite

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“… 42 While it is important to consider other socioeconomic confounders as potential contributors to these findings as well as the consequences of out-of-pocket costs and cost-sharing for opioid use, our study suggests that Medicaid patients remain at higher risk for opioid-related harms compared with patients with other payer types despite considerable improvement in opioid outcomes during the study period. 43 , 44 , 45 , 46 , 47 , 48 …”

Section: Discussionmentioning

confidence: 99%

Prescribed Opioid Dosages, Payer Type, and Self-Reported Outcomes After Surgical Procedures in Michigan, 2018-2020

et al. 2023

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ImportanceCollaborative quality improvement (CQI) models, often supported by private payers, create hospital networks to improve health care delivery. Recently, these systems have focused on opioid stewardship; however, it is unclear whether reduction in postoperative opioid prescribing occurs uniformly across health insurance payer types.ObjectiveTo evaluate the association between insurance payer type, postoperative opioid prescription size, and patient-reported outcomes in a large statewide CQI model.Design, Setting, and ParticipantsThis retrospective cohort study used data from 70 hospitals within the Michigan Surgical Quality Collaborative clinical registry for adult patients (age ≥18 years) undergoing general, colorectal, vascular, or gynecologic surgical procedures between January 1, 2018, and December 31, 2020.ExposureInsurance type, classified as private, Medicare, or Medicaid.Main Outcomes and MeasuresThe primary outcome was postoperative opioid prescription size in milligrams of oral morphine equivalents (OME). Secondary outcomes were patient-reported opioid consumption, refill rate, satisfaction, pain, quality of life, and regret about undergoing surgery.ResultsA total of 40 149 patients (22 921 [57.1%] female; mean [SD] age, 53 [17] years) underwent surgery during the study period. Within this cohort, 23 097 patients (57.5%) had private insurance, 10 667 (26.6%) had Medicare, and 6385 (15.9%) had Medicaid. Unadjusted opioid prescription size decreased for all 3 groups during the study period from 115 to 61 OME for private insurance patients, from 96 to 53 OME for Medicare patients, and from 132 to 65 OME for Medicaid patients. A total of 22 665 patients received a postoperative opioid prescription and had follow-up data for opioid consumption and refill. The rate of opioid consumption was highest among Medicaid patients throughout the study period (16.82 OME [95% CI, 12.57-21.07 OME] greater than among patients with private insurance) but increased the least over time. The odds of refill significantly decreased over time for patients with Medicaid compared with patients with private insurance (odds ratio, 0.93; 95% CI, 0.89-0.98). Adjusted refill rates for private insurance remained between 3.0% and 3.1% over the study period; adjusted refill rates among Medicare and Medicaid patients decreased from 4.7% to 3.1% and 6.5% to 3.4%, respectively, by the end of the study period.Conclusions and RelevanceIn this retrospective cohort study of surgical patients in Michigan from 2018 to 2020, postoperative opioid prescription size decreased across all payer types, and differences between groups narrowed over time. Although funded by private payers, the CQI model appeared to have benefitted patients with Medicare and Medicaid as well.

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“…This is contrary to adult literature suggesting that opioid prescriptions are higher in lower‐income people 27,28 . Possible explanations are that providers have a more comprehensive discussion about risks of opioids with higher income parents and may prescribe these families a small quantity of opioids “just‐in‐case.” Another explanation could be that lower income families could not afford to fill prescriptions 29 . Hispanic patients were less likely to receive opioids and when they did, received smaller quantities.…”

Section: Discussionmentioning

confidence: 99%

Opioid Prescribing Patterns Following Pediatric Tonsillectomy in the United States, 2009–2017

et al. 2020

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Objectives Assess national trends in opioid prescription following pediatric tonsillectomy: 1) overall percentage receiving opioids and mean quantity, 2) changes during 2009–2017, and 3) determinants of prescription patterns. Methods Cross‐sectional analysis using 2009–2017 Optum claims data to identify opioid‐naïve children aged 1–18 with claims codes for tonsillectomy (n = 82,842). Quantities of opioids filled in outpatient pharmacies during the perioperative period were extracted and converted into milligram morphine equivalents (MMEs) for statistical comparison. Demographic, clinical, and socioeconomic predictors of opioid fill rate and quantity were determined using regression analyses. Results In 2009, 83.3% of children received opioids, decreasing to 58.3% by 2017. Rates of all‐cause readmissions and post‐tonsillectomy hemorrhages were similar over time. Mean quantity received was 153.47MME (95% confidence intervals [95%CI]: 151.19, 155.76) and did not significantly change during 2009–2017. Opioids were more likely in older children and those with higher household income, but less likely in children with obstructive sleep apnea, other comorbidities, and Hispanic race. Higher quantities of opioids were more likely in older children, while lower quantities were associated with female sex, Hispanic race, and higher household income. Outpatient steroids were prescribed to 8.04% of patients, who were less likely to receive opioids. Conclusion While the percentage of children receiving post‐tonsillectomy opioids decreased during 2009–2017, prescribed quantities remain high and have not decreased over time. Prescription practices were also influenced by clinical and sociodemographic factors. These results highlight the need for guidance, particularly with regard to opioid quantity, in children after tonsillectomy. Level of Evidence N/A Laryngoscope, 131:E1722–E1729, 2021

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Association between insurance cost-sharing subsidy and postoperative opioid prescription refills among Medicare patients

Cited by 6 publications

References 42 publications

Insurance, Policy, Knowledge Level and Epidemiology As Factors Affecting Demand And Supply of Pharmaceutical Product

Insurance, Policy, Knowledge Level and Epidemiology As Factors Affecting Demand And Supply of Pharmaceutical Product

Prescribed Opioid Dosages, Payer Type, and Self-Reported Outcomes After Surgical Procedures in Michigan, 2018-2020

Opioid Prescribing Patterns Following Pediatric Tonsillectomy in the United States, 2009–2017

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