The Effect of a Federal Controlled Substance Act Schedule Change on Hydrocodone Combination Products Claims in a Medicaid Population

Abstract

No outside funding supported this study. The authors have nothing to disclose. Study concept and design were contributed by all authors except for Arnold and Clements. Tran, Arnold, and Clements took the lead in data collection, along with Peristere, and data interpretation was performed by all the authors, except Arnold. The manuscript was written primarily by Tran, along with Lavitas, Stevens, and Greenwood, and revised by all the authors except Arnold and Peristere. A poster of this research project was presented at the Academy of Managed Care Pharmacy's 2016 Annual Meeting in San Francisco, California, April 2016.

Using trajectory models to assess the effect of hydrocodone upscheduling among chronic hydrocodone users

“…This finding is consistent with previous studies that have that shown limited substitution effects among closed cohorts of HCP users that were analyzed before and after the schedule change . Studies that have reported increases in the use of alternative analgesics after HCP rescheduling have been primarily set in emergency departments, poison control centers and single provider outpatient settings, and their findings are likely to represent the impact of system‐level changes on both new and continuing HCPs users .…”

“…Several studies have examined in the impact of the hydrocodone schedule change on opioid prescribing. These studies have consistently demonstrated that the upscheduling decreased the prescribing and dispensing of both hydrocodone combination products and opioids in general . For example, an analysis of nationwide prescription sales data indicated that the schedule change was associated with 1.1 billion fewer hydrocodone combination product tablets and 26.3 million fewer prescriptions during the year after it went into effect .…”

“…For example, an analysis of nationwide prescription sales data indicated that the schedule change was associated with 1.1 billion fewer hydrocodone combination product tablets and 26.3 million fewer prescriptions during the year after it went into effect . Similarly, a review of a single academic tertiary emergency department reported significant declines in hydrocodone use as well as increased use of alternative opioid and nonopioid analgesics . Despite the insights that these studies provide, little is known regarding the effects of upscheduling on long‐term hydrocodone users, who theoretically might be most affected by restrictions on submitting prescriptions via fax or phone.…”

Internal validation of Medicaid Analytic eXtract (MAX) data capture for comprehensive managed care plan enrollees from 2007 to 2010

“…In an effort to better manage and monitor the Medicaid program and associated health care delivery system nationally, administrative claims files of individual states are compiled and transformed into a consistent and research‐friendly format, the Medicaid Analytic eXtract (MAX) files . Medicaid Analytic eXtract files serve as a valuable resource to understand and address disparities in health and health care for these vulnerable populations and are used extensively to study the epidemiology and burden of diseases, health care delivery and policy, and their benefits, harms, and costs among Medicaid beneficiaries …”

“…As a result, most researchers have relied on the analysis of enrollees in traditional FFS and primary care case management plans in which reimbursement for providers is paid and thus recorded on an FFS basis . Given the significant increase in managed care penetration in Medicaid in recent years, this practice faces issues of depleted sample size and limited generalizability with more than half of the intended study population missing.…”