Implementation of an Opioid Management Initiative by a State Medicaid Program
Implementation of an Opioid Management Initiative by a State Medicaid Program
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DOI：
10.18553/jmcp.2014.20.5.447
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发表时间：
2014-05-01
影响因子：
2.1
通讯作者：
Jeffrey, Paul
中科院分区：
文献类型：
--
作者：
Garcia, Maria M.;Angelini, Michael C.;Jeffrey, Paul
背景：在过去的20年中，处方阿片类药物的使用有所增加。与此相关的是滥用处方阿片类药物用于非医疗目的。Mecicaid计划一直在努力制定策略，平衡最佳实践模型，适当利用，并减少与opidd药物class.Objective相关的费用，以检查为期2年的逐步倡议的影响，以减少长效阿片类镇痛药MCA的利用和治疗费用，通过解决填充剂量，日剂量，方法回顾和比较2个时间段的来自马萨诸塞州医疗补助药房计划的LAOA的利用数据。该举措之前的日历年，即2002年，被用作基准年，代表对成员获取长效类阿片没有限制的时期。2005日历年是比较年，是在该倡议的多个步骤得到执行之后的一个时期。进行了一项基于索赔的回顾性分析，以确定对LAOA的限制的影响，LAOA定义为羟考酮BR、吗啡BR、美沙酮和芬太尼透皮系统的品牌和通用版本。主要指标是在实施阿片类药物管理计划后，每个LAOA的独特使用者、付费母兽和平均日剂量的变化百分比。次要措施包括成本analysis.RESULTS：与2002年相比，LAOA独特利用者的总数下降了17.8%（P< 0.0001），水坝的总数下降了4.1%（P< 0.0001），而医疗补助药房福利会员注册保持相对稳定。美沙酮和吗啡BR的平均日剂量下降，羟考酮BR和芬太尼透皮系统的平均日剂量增加。2005年LA的总成本：与2002年的总成本相比下降了8.0%。2002年，添加用户的每个成员每月（RAW）费用为110.57美元（按2005年美元调整后为120.04美元），而2005年为12375美元。在加拿大，2002年所有成员的总体PMPM为3.52美元（调整为2005年美元时为3.82美元），而2005年为3.59美元。结论：或研究成功地证明，州医疗补助计划倡议可以导致阿片类药物使用的总体显著下降，特别是针对目标，更昂贵的药物。这是通过实施治疗类管理多学科工作组实现的，该工作组建立了实施剂量限制的事先授权过程，并确定了首选的成本较低的药物。它进一步促进了LAOA适应症管理的药房-处方者合作的直接机会。版权所有（C）2014年，管理护理药房学院。All rights reserved.
BACKGROUND: The utilization of prescription opioids has increased ever the last 2 decades. Associated with this is the misuse of prescription opioids for nonmedical purposes. Mecicaid programs have struggled with developing strategies that balance best practice models, appropriate utilization, and reduction in costs associated with the opidd medication class.OBJECTIVE To examine the impact of a 2-year stepwise initiative to reduce utilization and therapy costs of long-acting opioid analgesics MCA) by adcfressing issues of fill dose, daily dose, and preferred therapeutic alternatives.METHODS Utilization data from the Massachusetts Medicaid pharmacy program for LAOAs were reviewed and compared for 2 time periods. The calendar year prior to the initiative, 2002, was used as a base year and represents a time period when there were no restrictions in place for members to obtain long-acting opioids. The calendar year 2005 was the comparison year representing a time period after the multiple steps of the initiative had been implemented. A retrospective claims-based analysis was performed to determine the impact of restrictions on LAOAs, defined as brand and generic versions of oxycodone BR, morphine BR, methadone, and fentanyl transdermal system The primery measure was the percentage of change of unique utilizers, paid dams, and average daily dose for each LAOA following the implementation of the opioid management initiative. Secondary measures included a cost analysis.RESULTS: Compared with 2002, the overall number of LAOA unique utilizers declined 17.8% (P< 0.0001), and the overall number of dams declined by 4.1% (P< 0.0001), while Medicaid pharmacy benefit member enrollment remained relatively stable. Average daily dose declined in methadone and morphine BR and increased in oxycodone BR and fentanyl transdermal system. The 2005 overall cost of LA:As decreased 8.0% compared with the overall cost in 2002. The per- member-per-month (RAW) cost for add users in 2002 was $110.57 ($120.04 when adjusted to 2005 dollars) compared with $12375 in 2005. In canparison, the overall PMPM for all members in 2002 was $3.52 ($3.82 when adusted to 2005 dollars) compared with $3.59 in 2005.CONCLUSIONS: Or study successfully demonstrated that a state Medicaid program initiative can result in a significant overall decrease in opioid class utilization specifically for the targeted, more costly agents. This was achieved via the implementaticn of a Therapeutic class Management multidisciplinary workgrcup that established a prior authorization process implementing limits on dose, as well as identified preferred less costly agents. It further facilitated the direct opportunity for pharmacy-prescriber collaboration for LAOA rnedication management . Copyright (C) 2014, Academy of Managed Care Pharmacy. All rights reserved.