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Regulating Opioid Supply Through Insurance Coverage.

M Christopher Auld1, Jill R Horwitz2, Benjamin Lukenchuk3

  • 1M. Christopher Auld is an associate professor of economics at the University of Victoria, in Victoria, British Columbia, Canada.

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Summary
This summary is machine-generated.

Canadian opioid policies reduced OxyContin prescriptions, especially for new patients. However, regulations showed no impact on hospitalizations, indicating varied effects on opioid substitution and patient groups.

Keywords:
Drug useFormulariesGlobal healthHealth policyInsurance market regulationMortalityOpioid use disorderPatient harmPharmaceuticalsPrescription drugsRegulation

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Area of Science:

  • Public Health
  • Pharmacoeconomics
  • Health Policy

Background:

  • Canada faces an ongoing opioid crisis, prompting unique supply-side policy interventions.
  • Previous US strategies focused less on insurance reimbursement regulations for opioid prescribing.

Purpose of the Study:

  • To evaluate the impact of Canadian pharmaceutical formulary restrictions on opioid prescribing and hospitalizations.
  • To assess the differential effects of these policies on opioid-naive versus chronic opioid users.

Main Methods:

  • Analysis of national databases for all opioid prescriptions dispensed via provincial programs (Jan 2006–Mar 2017).
  • Examination of opioid hospitalization data over the same period.
  • Comparison of prescription fills and hospitalizations before and after specific regulatory changes, including prior authorization and 'grandfathering' policies.

Main Results:

  • Prior authorization for OxyContin significantly reduced its prescription fills, particularly among opioid-naive patients, and decreased overall opioid prescriptions.
  • Allowing existing OxyContin users to switch to OxyNeo ('grandfathering') increased OxyNeo fills but did not affect total opioid prescriptions, indicating substitution among chronic users.
  • No significant effects of these regulatory changes were observed on opioid-related hospitalizations.

Conclusions:

  • Pharmaceutical formulary restrictions can effectively reduce fills of targeted opioids like OxyContin.
  • These policies demonstrate differential impacts on opioid-naive patients versus chronic opioid users, suggesting potential for tailored interventions.
  • Canadian policymakers should consider expanding these regulations, and international bodies, including the US, could adopt similar strategies.