Opioid Prescriptions by Pain Medicine Physicians in the Medicare Part D Program: A Cross-Sectional Study.
Opioid Prescriptions by Pain Medicine Physicians in the Medicare Part D Program: A Cross-Sectional Study.
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Medicare Part D计划中疼痛医学医师的阿片类药物处方：一项横断面研究。
DOI：
10.1213/ane.0000000000005399
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发表时间：
2021-06-01
影响因子：
5.7
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中科院分区：
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疼痛医学医师（PMP）是一群在各种初级专业领域接受过背景培训的医师，他们对慢性疼痛疾病的管理有兴趣且具备专业知识。我们的目标是分析来自医疗保险D部分计划中与PMP相关的处方药（PD）报销数据，以深入了解其模式、相关成本以及潜在的成本节约领域。
D部分报销数据的主要数据源是医疗保险和医疗补助服务中心（CMS）的慢性病数据仓库，其中包含在报销提交截止日期前收到的医疗保险D部分处方药事件（PDE）记录。只有疼痛管理（PM）和介入性疼痛管理（IPM）分类的医疗服务提供者被纳入研究。对PDE的分析仅限于报销次数超过250次的药物。根据药物类别和医疗服务提供者的专业对报销和成本的分布进行了分析。随后，我们详细探究了阿片类药物处方的报销和费用情况。对按成本和报销次数排名前5%的医疗服务提供者的处方特征进行了检查，以获取更多信息。对2017年PMP开具的排名前10的药物的成本和报销情况进行了探究。
在2017年医疗保险D部分计划中，共有3280种由PMP开具的独特药物，相关费用为6.52亿美元。与PMP相关的处方在该计划的药物支出中所占比例极小（0.4%）。在这一小部分中，阿片类药物、抗惊厥药和加巴喷丁类药物的报销次数最多，费用也最高。在阿片类药物处方中，与仿制药相比，品牌药的报销次数所占比例较小（8%），但其相关费用高于仿制药。按处方药成本排名前5%的处方医生的报销次数更多，开具品牌药的比例更高，并且其处方的用药天数供应更长。在与PMP相关的按成本排名前10的处方药清单中有几种阿片类药物。
在PMP开具的医疗保险D部分报销的药物中，阿片类药物是最常见的药物。在所有阿片类处方药报销中，只有12%是由PMP开具的。排名前5%的PMP处方医生的报销次数是普通PMP的10倍。
Pain medicine physicians (PMP) are a group of physicians with background training in various primary specialties with interest and expertise in managing chronic pain disorders. Our objective is to analyze prescription drug (PD) claims from the Medicare Part D program associated with PMP to gain insights into patterns, associated costs, and potential cost savings areas. The primary data source for Part D claims data is the Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Data Warehouse, which contains Medicare Part D prescription drug events (PDE) records received through the claims submission cutoff date. Only providers with taxonomies of pain management (PM) and interventional pain management (IPM) were included in the study. The analysis of PDE was restricted to drugs with >250 claims. The distribution of claims and costs were analyzed based on drug class and provider specialty. Subsequently, we explored claims and expenses for opioid drug prescriptions in detail. Prescribing characteristics of the top 5% of providers by costs and claims were examined to gain additional insights. The costs and claims were explored for the top 10 drugs prescribed by PMP in 2017. There were a total of unique 3280 PMP-prescribed drugs with an associated expense of 652 million dollars in the 2017 Medicare Part D program. Prescriptions related to PMP account for a tiny fraction of the program’s drug expenditure (0.4%). Opioids, anticonvulsants, and gabapentinoids were associated with the largest number of claims and the largest expenses within this fraction. Among opioid drug prescriptions, brand-named drugs account for a small fraction of claims (8%) compared to generic drugs. However, the expenses associated with brand name drugs were higher than generic drugs. Prescribers in the top 5% by PD costs had a higher number of claims, prescribed a higher proportion of branded medications, and had prescriptions associated with longer day supply compared to an average PMP. There were several opioid medications in the top 10 PD list by cost associated with PMP. Opioids were the most common medications among Medicare part D claims prescribed by PMP. Only 12% of the total opioid PD claims were by PMP. The top 5% of PMP prescribers had 10 times more claims than the average PMP.