Medicaid prior authorization and controlled-release oxycodone.

Area of Science:

• Health Services Research
• Pharmaceutical Policy
• Pain Management

Background:

• Controlled-release (CR) oxycodone use has risen since 1996, prompting Medicaid programs to implement prior authorization (PA) policies to manage costs.
• Few studies have evaluated the effectiveness of these PA policies, particularly comparing strict versus lenient approaches across different states.

Purpose of the Study:

• To estimate the impact of prior authorization (PA) policies on the utilization of controlled-release (CR) oxycodone among Medicaid beneficiaries.
• To compare the effects of strict and lenient PA policies on CR oxycodone use and associated expenditures.

Main Methods:

• Analysis of aggregate Medicaid prescription dispensing records from all 50 states between 1996 and 2005.
• Systematic collection of prior authorization (PA) policy details.
• Regression and random effects meta-analyses to assess the impact of PA policies on CR oxycodone use and expenditures.

Main Results:

• CR oxycodone constituted 12.4% of all opiates and 32.2% of long-acting opiates dispensed to Medicaid beneficiaries in 2004.
• Prior authorization (PA) implementation was associated with state-specific changes in CR oxycodone use ranging from -76% to 9%.
• Aggregate analysis showed a nonsignificant decrease in CR oxycodone use but a significant 8% reduction in its proportion among long-acting opiate doses, with strict policies demonstrating greater effects.

Conclusions:

• The impact of prior authorization (PA) on CR oxycodone use in Medicaid varied significantly by state and was less pronounced than anticipated.
• Controlled-release (CR) oxycodone appears relatively resistant to PA interventions, necessitating the development of more refined prescription management strategies.
• Further investigation is required to identify effective strategies for managing CR oxycodone prescription patterns within Medicaid programs.