The Impact of Benefit Design and Formulary Practices on Opioid Abuse and Overdose

描述（由申请人提供）：拟议的研究将研究福利设计和处方集管理-健康保险中的两种常用工具-是否可以应用于解决处方药滥用和过量的公共卫生问题。尽管福利设计和处方管理在健康保险中普遍存在，但关于这些策略如何减少阿片类药物滥用及其健康和经济后果的现有研究很少。我们建议评估这些策略的变化对以下方面的影响：（1）基于声明的阿片类药物使用指标，这些指标是滥用的指标（例如，多药治疗、“医生购物”、剂量和处方计数）;（2）健康结果（例如，过量）与阿片类药物误用和滥用相关，并从索赔数据推断;和（3）相关的卫生系统支出。我们建议在两个不同但相关的患者人群和医疗保健系统环境中进行评估，即工人的赔偿和符合SSDI条件的残疾人医疗保险人群。我们选择这些人群和系统是因为他们最近在福利和处方策略的不同方面经历了变化，并且因为工伤和某些残疾与阿片类药物和其他可能滥用的药物的利用率较高有关。我们的半实验性， 差异中的差异评估方法利用了美国两大州德克萨斯州和加州的差异，以最大限度地推断特定的政策变化。我们的目标是1）。制定和应用基于药房索赔的阿片类药物使用措施; 2.）评估封闭式药物处方集的引入是否会影响阿片类药物的使用、与滥用相关的健康结果以及工人赔偿人群的相关支出;以及3.评估医疗保险D部分成本分摊和处方集管理是否影响阿片类药物的使用，滥用相关的健康结果和相关支出。 拟议的研究直接解决了2020年健康人的两个优先事项：1。减少药物引起的死亡; 2.）减少过去一年处方药的非医疗使用。该研究认识到获得阿片类药物处方，滥用处方药，滥用处方药与健康结果和医疗保健系统相关成本方面的危害之间的联系。它将有助于建立证据基础，将政策工具与处方药滥用和过量相关结果的变化联系起来。就本研究而言，感兴趣的政策工具具有公共政策和私营部门的影响和实施潜力。 福利设计和处方集管理是医疗保险中无处不在的工具，但它们与处方药滥用及其后果相关的结果的联系却知之甚少。我们提出的研究将为保险公司和政策制定者提供所需的信息，以制定更有效的策略，减少处方药的误用，滥用和过量。

DESCRIPTION (provided by applicant): The proposed research will study whether benefit design and formulary management - two common tools in health insurance generally - can be applied to address the public health problems of prescription drug abuse and overdose. Despite the ubiquity of benefit design and formulary management in health insurance generally, there is very little existing research on how these strategies can reduce opioid abuse and its health and economic consequences. We propose to evaluate the impact of changes in these strategies on (1) claims-based measures of opioid utilization that are indicators of misuse (e.g., polypharmacy, "doctor shopping", dosage, and prescription counts); (2) health outcomes (e.g., overdose) associated with opioid misuse and abuse and extrapolated from claims data; and (3) associated health system spending. We propose to conduct our evaluation in two different but related patient populations and health care system settings, namely workers' compensation and SSDI-eligible disabled Medicare populations. We selected these populations and systems because they have both recently experienced changes in different aspects of benefit and formulary strategy, and because workplace injuries and certain disabilities are associated with higher utilization of opioids and other drugs with the potential for abuse. Our quasi-experimental, differences-in-differences evaluation methodology leverages differences across two large US states, Texas and California, to maximize inference on specific policy changes. Our Specific Aims are to 1.) Develop and apply pharmacy claims-based measures of opioid utilization; 2.) Assess whether the introduction of a closed drug formulary affects opioid utilization, abuse-related health outcomes, and associated spending in a workers' compensation population; and 3.) Assess whether Medicare Part D cost sharing and formulary management affect opioid utilization, abuse-related health outcomes, and associated spending. The proposed research directly addresses two Healthy People 2020 priorities: 1.) reduce drug induced deaths; and 2.) reduce the past-year nonmedical use of prescription drugs. The study recognizes the links between access to opioid prescriptions, misuse of prescription drugs, abuse of prescription drugs, and harms in terms of health outcomes and associated costs to the health care system. It will contribute to the evidence base linking policy tools to changes in outcomes related to prescription drug abuse and overdose. In the case of this study, the policy tools of interest have both public policy and private-sector implications and potential for implementation. Benefit design and formulary management are ubiquitous tools in health insurance, but their link to outcomes related to prescription drug abuse and its consequences is poorly understood. Our proposed research will provide insurers and policymakers with the information needed to craft more effective strategies to reduce misuse, abuse, and overdose due to prescription drugs.