The Influence of Formulary Management Strategies on Opioid Medication Use.

描述（由申请人提供）：有问题的处方阿片类药物消费（包括大量使用和滥用）和过量的后果在美国已经达到流行病的程度，是一个主要的公共卫生问题。与有问题的阿片类药物消费和过量有关的一些后果，包括合并症的健康问题和死亡，加剧了这一问题的严重性。处方药监测计划等战略对阿片类药物的获取和过量使用的影响有限。越来越需要解决医生处方和消费者使用阿片类药物的方法。首选药物处方和使用管理工具对于支付者控制处方、消费和随后的过量是有价值的策略。以前对商业和公共计划中处方和首选药物清单实施情况的研究表明，在一些药物类别中，处方填写减少了。此外，研究表明，将药物转移到事先授权清单会导致处方减少。然而，关于提供者因素和处方如何影响阿片类药物消费和过量，人们知之甚少。本研究将检查处方管理策略对宾夕法尼亚州医疗补助计划中有问题的处方阿片类药物消费和过量模式的影响。医疗补助是处方阿片类药物的重要支付者，覆盖了阿片类药物滥用高风险的弱势群体。宾夕法尼亚州拥有全国第四大医疗补助计划，并与几家管理医疗机构签订了长期合同，每家机构都制定了自己的处方和管理药物使用的方法。因此，我们可以利用2007-2012年间每年覆盖200多万人的保险计划中丰富的横断面和纵向变化的配方设计。有了这些数据，这项研究将：

DESCRIPTION (provided by applicant): Consequences of problematic prescription opioid consumption (which includes heavy use and misuse) and overdose have reached epidemic proportions in the United States and are a major public health concern. A number of repercussions associated with problematic opioid consumption and overdose, including co-morbid health problems and deaths, add to the seriousness of this issue. Strategies, such as Prescription Drug Monitoring Programs, have had a limited impact on access to opioids and overdose. There is a growing need for approaches that addresses both physicians' prescribing as well as consumers' use of opioid medications. Preferred drug formularies and utilization management tools stand to be valuable strategies for payers to control prescribing, consumption, and subsequent overdose. Previous studies of formulary and preferred drug list implementation in commercial and public plans have demonstrated reductions in prescription filling among a number of medication classes. Furthermore, research has shown that shifting medications to prior authorization lists results in prescription decreases. However, little is know about how provider factors and formularies influence opioid consumption and overdose. This study will examine the effect of formulary management strategies on patterns of problematic prescription opioid consumption and overdose in the Pennsylvania Medicaid program. Medicaid is an important payer for prescription opioids and covers a vulnerable population at high risk of opioid misuse. Pennsylvania has the 4th largest Medicaid program in the country and has long-standing contracts with several managed care organizations, each of which develops its own formulary and approach to managing drug utilization. As such, we can take advantage of rich cross-sectional and longitudinal variation in formulary design in an insurance program covering more than 2 million people annually between 2007-2012. With these data, the study will: 1. identify patient- and provider-level risk factors associated with opioid overdose and trajectories of opioid consumption that precede overdose in Medicaid and 2. examine effects of formulary/utilization management tools on overdose and problematic use. This study will enrich our understanding of the effects of formularies on prescription opioid use among Medicaid enrollees. Results from this study will be directly disseminated to Pennsylvania Medicaid program administrators who can implement statewide policies to slow or reduce problematic prescription opioid consumption, overdoses, and death.