Impact of Sequential Opioid Dose Reduction Interventions in a State Medicaid Program Between 2002 and 2017

Area of Science:

• Public Health
• Health Policy
• Pharmacology

Background:

• High-risk opioid prescribing is a significant public health concern.
• Opioid dose limits are a policy tool to mitigate risks associated with opioid use.
• Massachusetts Medicaid implemented progressive high-dose (HD) opioid limits over 15 years.

Purpose of the Study:

• To evaluate the impact of sequential decreases in high-dose opioid limits on prescribing patterns.
• To assess the effectiveness of prior authorization policies in reducing high-dose opioid prescriptions.

Main Methods:

• The study analyzed Massachusetts Medicaid claims for opioid use between 2002 and 2017.
• Three interventions involved prior authorization for morphine equivalent doses (MED) exceeding 360 mg, 240 mg, and 120 mg.
• Segmented regression analyzed changes in the natural log of average daily MED (AD_MED).

Main Results:

• The natural log of AD_MED significantly decreased after each of the three prior authorization interventions.
• The percentage of users exceeding HD limits of 360 mg, 240 mg, and 120 mg MED decreased by 87.3%, 79.8%, and 75.2%, respectively.
• Sequential reductions in HD limits effectively lowered average daily opioid dosage and reduced the proportion of high-dose prescribers.

Conclusions:

• Sequential prior authorization limits for high-dose opioids in Medicaid demonstrably reduce average daily opioid dosage.
• This policy strategy offers a viable approach for policymakers to address high-risk opioid prescribing and the opioid epidemic.
• Prior authorization for high-dose opioid limits is an effective tool for Medicaid programs to manage opioid prescribing.