The Influence of Formulary Management Strategies on Opioid Medication Use.

描述(由申请人提供)：问题处方阿片类药物消费(包括大量使用和误用)和过量使用的后果在美国已经达到流行的程度，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，包括并存的健康问题和死亡，增加了这个问题的严重性。诸如处方药监测方案等战略对阿片类药物的获得和过量用药的影响有限。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来说是控制处方、消费和随后的过量用药的有价值的策略。以前对商业和公共计划中处方和首选药物清单执行情况的研究表明，在一些药物类别中，处方填充量减少了。此外，研究表明，将药物转移到事先授权的名单会导致处方减少。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。这项研究将审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服药模式的影响。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风险较高的弱势人群。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，每一家机构都制定了自己的处方和管理药物使用的方法。因此，我们可以在2007-2012年间每年覆盖200多万人的保险计划中利用处方设计中丰富的横向和纵向差异。有了这些数据，研究将： 1.确定与阿片类药物过量有关的患者和提供者一级的风险因素以及在医疗补助和医疗补助中过量使用阿片类药物之前的阿片类药物消费轨迹 2.审查处方/使用管理工具对过量和有问题的使用的影响。 这项研究将丰富我们对处方对医疗补助参与者处方阿片类药物使用的影响的理解。这项研究的结果将直接传播给宾夕法尼亚州的医疗补助计划管理员，他们可以实施全州范围的政策，以减缓或减少有问题的处方阿片类药物的消费、过量和死亡。

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.