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Impact of Medicare Part D opioid safety policies on disabled beneficiaries before and during the COVID-19 pandemic

Medicare D 部分阿片类药物安全政策在 COVID-19 大流行之前和期间对残疾受益人的影响

基本信息

批准号：
10345593
负责人：
Hefei Wen
金额：
$ 70.11万
依托单位：
HARVARD PILGRIM HEALTH CARE, INC.
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-08-15 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10345593
关键词：
Accident and Emergency department Adverse event Age American Authorization documentation Buprenorphine COVID-19 COVID-19 pandemic Caring Clinical Consult Consultations Coupled Data Disabled Persons Dose Drug Utilization Review Emergency Situation Ensure Environment Evaluation Federal Government Healthcare Hospitalization Improve Access Inpatients Intellectual functioning disability Intervention Medical Medicare Medicare claim Mental disorders Morphine Musculoskeletal Diseases Opioid Patients Pharmaceutical Preparations Pharmacists Play Policies Population Quasi-experiment Regulation Rural Rural Community Safety Signal Transduction System Time United States Centers for Medicare and Medicaid Services base beneficiary care coordination chronic pain cohort disability ethnic minority fight against flexibility high risk high risk population implicit bias interest medically underserved milligram minority patient mortality opioid epidemic opioid tapering opioid therapy opioid use disorder overdose death pandemic disease post intervention prescription opioid racial and ethnic response rural patients telehealth

项目摘要

PROJECT SUMMARY/ABSTRACT Representing ~3% of the U.S. population, non-elderly disabled Medicare beneficiaries (henceforth “disabled beneficiaries”) account for ~25% of overdose deaths and hospitalizations related to prescription opioids. Among disabled beneficiaries, opioid-related harms are concentrated in the 20-25% who are prescribed long- term opioid therapy, primarily for chronic pain. We will first examine effects of a recent, important policy intervention – Medicare Part D opioid safety edits – on an understudied, high-risk cohort of disabled beneficiaries who are prescribed long-term, high-dose opioid therapy (Aim 1). Effective January 1, 2019, Medicare Part D plans are required to incorporate a set of enhanced safety edits into their drug utilization review systems. The most salient is a “care coordination edit” alerting pharmacists when daily doses of opioid prescriptions exceed 90 morphine milligram equivalence. The new Medicare Part D opioid safety policy is intended to identify overprescribing through pharmacist-prescriber consultation without directly restricting patient access (intended beneficial effect). It may also encourage the initiation of buprenorphine for opioid use disorder treatment in lieu of high-dose opioid regimes (beneficial spillover effect). However, the possible misinterpretation of the 90-MME threshold as a “hard stop”, coupled with administrative burdens, may prompt rapid dose reduction and abrupt discontinuation (unintended detrimental effect). Furthermore, overrepresented among disabled beneficiaries, racial/ethnic minority patients and rural patients may be less likely to benefit from the Medicare Part D opioid safety policy and more susceptible to unintended harms (Aim 2). The Medicare Part D opioid safety policy is now playing out against a backdrop of the COVID-19 pandemic. To minimize potential disruptions to health care, the federal government has made temporary changes to the Medicare telehealth and opioid regulations, which may facilitate the beneficial effects of the Medicare Part D opioid safety policy and alleviate the detrimental policy effects (Aim 3). We will use 2017-22 Medicare claims data and a quasi-experimental design. We will assess appropriate opioid tapering (intended beneficial effect), inappropriate opioid tapering (unintended detrimental effect), buprenorphine initiation (beneficial spillover effect), and opioid-related adverse events in emergency department and inpatient settings (downstream effect). We aim to: 1. Examine effects of the first-year, pre-pandemic implementation of the Medicare Part D opioid safety policy on disabled beneficiaries who are prescribed long-term, high-dose opioid therapy; 2. Compare racial/ethnic and rural-urban differences in policy effects; 3. Extend Aims 1 and 2 to the pandemic and post-pandemic eras to elucidate the interaction of the Medicare Part D opioid safety policy with flexibilities provided during the COVID-19 emergency and beyond. Our findings will enable policymakers to develop clinically and culturally nuanced policies and practices tailored to the disabled population, the racial/ethnic minority patients and rural patients, and the evolving pandemic/post-pandemic environment.

项目总结/文摘