Patient Outcomes in a Medicaid Managed Care Lock-In Program

Area of Science:

• Public Health
• Pharmacology
• Health Services Research

Background:

• Opioid abuse is a significant public health crisis in the United States.
• Managed care organizations utilize pharmacy lock-in programs to mitigate prescription opioid misuse.
• These programs restrict patients to a single prescriber for opioid prescriptions.

Purpose of the Study:

• To evaluate opioid use patterns in Medicaid managed care patients within a pharmacy lock-in program.
• To assess the effectiveness of assigned prescriber limitations on opioid coverage.

Main Methods:

• Retrospective cohort study of Blue Care Network (BCN) Michigan Medicaid managed care patients (March 2008 - May 2013).
• Outcomes assessed using BCN claims, Michigan Automated Prescription System, and controlled substance reports.
• Patients categorized as 'stable' (adhering to assigned prescribers or receiving opioid dependence treatment) or 'unstable' (cash purchases or non-assigned provider claims).

Main Results:

• Over half (55.9%) of the 59 enrolled patients discontinued BCN coverage.
• The rate of coverage discontinuation decreased over time.
• Among patients remaining in the program, the proportion classified as 'stable' increased from 31% at 6 months to 78% at 36 months.

Conclusions:

• A significant number of patients exited the program by dropping coverage, an unintended consequence requiring further investigation.
• Patients who remained enrolled largely achieved desired outcomes, indicating program effectiveness in addressing opioid abuse.
• The program demonstrated a positive role in managing opioid use among enrolled patients.