Commercial and public payer opioid analgesic prescribing policies: A case study

Abstract

Background: One strategy to address the high number of U.S. opioid-related deaths is to restrict high-risk or inappropriate opioid analgesic prescribing and dispensing. Federal and state laws and regulations have implemented restrictions but less is known about commercial and public payers’ policies aside from clinician anecdotal reports that these policies are increasing. To assess the number and types of policies with temporal trends, we examined commercial and public (Medicaid) payer policies in one state, Michigan, that has high opioid-related deaths and implemented opioid analgesic prescribing laws. Between 2015 and 2018 claims paid by commercial payers dropped 30.5% and 15.2% for public payer, suggesting the impact of federal and state laws and regulations, media, advocacy groups, education, and payer policies. Methods: Policies for seven large commercial payers and the public payer for 2012-2018 were reviewed and categorized by actions. Joinpoint regression was used to summarize temporal trends on number of policies for all payers and commercial and public payer subgroups. Results: Across the seven years, there were 529 action policies (75.57 (95% confidence intervals (CI) 35.93, 115.22) actions per year) with a range of 36 to 103 actions by payer. Limitations on number of days for initial prescriptions being most frequently implemented policy (83 policies and implemented at least once by all eight payers). The least frequently used policy was incentives to providers which was implemented once by one payer. The temporal trend showed a decline in new policies from 2012 to 2013 but a steady increase from 2014 to 2018 (average annual percent change=29.6% (95% confidence intervals 13.2%, 48.5%). The public payer (implemented 47 policies) showed no increase in number of policies over time (AAPC=2.9% (95% CI -41.6%, 61.6%). Conclusions: The eight commercial and public payers implemented many new policies to restrict opioid analgesic prescribing with a steady increase in the number of such policies implemented from 2014 to 2018. This case study documented that at least in one state with high opioid-related deaths and multiple commercial payers, new and different policies were increasingly implemented challenging clinicians providing patient care and researchers determining the impact. Key words : opioid prescribing, commercial insurance, public insurance, policies, regulations, temporal trends

Intentional Overdose Prevention in the Era of the 90-Day Prescription

“…Insurers should be more thoughtful of the risks posed to suicidal patients by strongly incentivizing 90-day medication supplies, especially because many insurers have already established their capacity to create prescription coverage policies that induce safer prescribing practices instead of potentially harmful ones. For example, the number of days supplied in an index opioid prescription has been linked to long-term opioid use, and many insurers recently have responded by adjusting their policies so that only short initial opioid prescriptions are covered without prior authorization (13), even when state laws mandate no such restrictions.…”