Incremental Effect of the Addition of Prescriber Restrictions on a State Medicaid's Pharmacy-Only Patient Review and Restriction Program
Incremental Effect of the Addition of Prescriber Restrictions on a State Medicaid's Pharmacy-Only Patient Review and Restriction Program
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DOI：
10.18553/jmcp.2017.23.8.875
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发表时间：
2017-08-01
影响因子：
2.1
通讯作者：
Nesser, Nancy J.
中科院分区：
文献类型：
--
作者：
Keast, Shellie L.;Pham, Timothy;Nesser, Nancy J.
背景技术背景：病人审查和限制计划（PRRP），用于国家医疗补助计划，以限制潜在的滥用和滥用阿片类药物和相关的控制药物，往往限制成员到一个单一的药房控制药物。虽然大多数州使用受限的药房访问模式，但并非所有州都包括受限的处方者访问。俄克拉荷马州医疗补助计划（MOK）于2014年7月在其PRRP中增加了处方者访问限制功能。目的：评估在MOK的仅限药房PRRP中增加处方者访问限制对注册成员的药房和资源利用的增量影响。方法：在药房注册至少6个月的MOK会员-2014年7月，只有PRRP被限制为最多3名受管制物质的处方者，并被确定为"病例"。“使用倾向评分法，根据人口统计学和基线医疗保健利用情况，将病例与MOK非PRRP招募人群的对照进行匹配。对2014年1月1日至2014年12月31日的数据进行了评价。分析了每个成员的每月医疗保健资源利用率，定义为医疗和药房成本，处方数量和每月每个成员的阿片类药物使用量（PMPM）。差异-无差异（DID）回归估计的变化，在资源利用2014年7月的政策changes.RESULTS：本研究包括378个控制和126例后，倾向匹配。每日吗啡当量、苯二氮卓类处方或维持处方无差异。两组短效阿片类药物（SAO）索赔的平均PMPM使用量均减少（P
BACKGROUND: Patient review and restriction programs (PRRPs), used by state Medicaid programs to limit potential abuse and misuse of opioids and related controlled medications, often restrict members to a single pharmacy for controlled medications. While most states use a restricted pharmacy access model, not all states include restricted prescriber access. Oklahoma Medicaid (MOK) added a restricted prescriber access feature to its PRRP in July 2014.OBJECTIVE: To evaluate the incremental effect that the addition of a prescriber restriction to MOK's pharmacy-only PRRP had on the pharmacy and resource utilization of the enrolled members.METHODS: MOK members with at least 6 months of enrollment in the pharmacy-only PRRP were restricted to a maximum of 3 prescribers for controlled substances in July 2014 and were identified as "cases." Using a propensity score method, cases were matched to controls from the MOK non-PRRP enrolled population based on demographics and baseline health care utilization. Data from January 1, 2014, through December 31, 2014, were evaluated. Each member's monthly health care resource utilization, defined in terms of medical and pharmacy costs, prescription counts, and opioid use per member per month (PMPM), was analyzed. A difference-indifferences (DID) regression estimated the change in resource utilization following the July 2014 policy change.RESULTS: This study included 378 controls and 126 cases after propensity matching. No differences were noted for daily morphine equivalents, benzodiazepine prescriptions, or maintenance prescriptions. There were decreases in mean PMPM use for both groups for short-acting opioid (SAO) claims (P