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A Health Plan's Formulary Led To Reduced Use Of Extended-Release Opioids But Did Not Lower Overall Opioid Use
Michael L Barnett1, Andrew R Olenski2, N Marcus Thygeson3
1Michael L. Barnett ( mbarnett@hsph.harvard.edu ) is an assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts.
Health Affairs (Project Hope)
|September 5, 2018
Summary
Insurers reduced extended-release (ER) opioid prescribing via prior authorization, but total opioid use remained unchanged. This formulary change curbed ER oxycodone initiation without substituting other ER opioids.
Area of Science:
- Health Services Research
- Pharmacoeconomics
- Public Health Policy
Background:
- Opioid prescribing is influenced by insurance formulary design.
- The impact of formulary changes on opioid use, specifically substitution effects, requires further investigation.
Purpose of the Study:
- To evaluate the effect of a prior authorization policy for extended-release (ER) oxycodone on opioid prescribing patterns.
- To determine if formulary changes lead to reduced opioid use or substitution between different opioid formulations.
Main Methods:
- A quasi-experimental design comparing Blue Shield of California enrollees to commercially insured Californians.
- Analysis of monthly opioid prescription fill data before and after policy implementation in July 2015.
- Evaluation of initiation rates for ER opioids and short-acting opioids, and overall opioid use in morphine milligram equivalents (MME).
Main Results:
- A 36% relative decrease in ER opioid initiation among Blue Shield enrollees compared to controls.
- The reduction was driven by decreased ER oxycodone initiation, with no observed substitution to other ER opioids.
- A 1.4% relative increase in short-acting opioid fills, with no significant change in overall opioid use (MME).
Conclusions:
- Prior authorization for ER opioids can effectively reduce initiation of high-risk extended-release formulations.
- Formulary interventions targeting specific opioid types may not decrease overall opioid consumption.
- Insurers can influence prescribing of specific high-risk opioids, but comprehensive strategies are needed to reduce total opioid use.