Opioid Analgesic Policies and Prescription Drug Abuse in State Medicaid Programs

描述（由申请人提供）：2009年，美国药物过量死亡人数超过了机动车事故死亡人数。阿片类镇痛药的误用和滥用，主要是通过医疗保健系统或从朋友或亲戚那里获得的，主导了这些趋势。从1997年到2007年，通过药店分发的阿片类镇痛剂数量增加了6倍多，大约是死于阿片类药物过量的人数的1/3。阿片类镇痛药在社会中的这种破坏性洪水反映了对更积极的疼痛治疗的呼吁以及许多不同阿片类镇痛药制剂的扩散。医疗保健支付者有机会通过索赔数据监测和处方药政策干预（如事先授权（PA）和处方集）对这一流行病产生积极影响。由于各州独立管理自己的医疗补助计划，因此有机会在类似的医疗补助人群中比较和对比不同的药房福利设计方法。作为对RFA-CE-14-002（预防处方药过量的研究）的回应，本提案的目的是量化三个州医疗补助计划（俄勒冈州、俄克拉荷马州、科罗拉多）中的药房福利设计如何影响阿片类镇痛药的使用、不当使用、滥用和不良健康结局。我们将通过三个目标来实现这一目标：首先，我们将估计在俄克拉荷马州实施的PA长效阿片类药物政策的影响。其次，我们将评估俄勒冈州实施的阿片类药物高剂量限制的影响。对于这两个目标，我们将采用一种准实验方法来比较使用和过量相关的结果与没有阿片类药物政策的州。最后，我们将联系俄勒冈州医疗补助和处方药监测计划（PAPK）数据，以评估通过支付现金购买阿片类药物来规避医疗补助政策的患者的频率和特征。虽然这一目标在很大程度上是描述性的，但它代表了一种创新的方法，将促进我们对处方药福利人群中阿片类药物现金支付流行病学的理解。从这个项目中获得的知识与州医疗补助计划有关，至少有两个原因。首先，医疗补助接受者更有可能患有药物滥用障碍，并且在过量死亡中所占比例不成比例。其次，在未来几年，许多高风险人群（例如最近被监禁的人）将通过《平价医疗法案》的扩大获得医疗补助。确定促进适当和安全使用阿片类镇痛药的政策至关重要。

DESCRIPTION (provided by applicant): In 2009, drug overdose deaths surpassed deaths due to motor vehicle accidents in the US. Misuse and abuse of opioid analgesics, primarily obtained through the healthcare system or from friends or relative, have dominated these trends. From 1997 to 2007 the volume of opioid analgesics dispensed through pharmacies has increased more than 6-fold, and roughly paralleled the number of people dying from opioid overdoses. This damaging flood of opioid analgesics in society reflects both calls for more aggressive treatment of pain as well as the proliferation of many different opioid analgesic formulations. Healthcare payers have an opportunity to positively impact this epidemic through claims data monitoring and prescription drug policy interventions such as prior authorization (PA) and formularies. Because states independently administer their own Medicaid programs, there are opportunities to compare and contrast differing approaches to pharmacy benefit design across similar Medicaid populations. In response to RFA-CE-14-002 (Research to Prevent Prescription Drug Overdoses), the objective of this proposal is to quantify how pharmacy benefit designs in three state Medicaid programs (Oregon, Oklahoma, Colorado) impact opioid analgesic utilization, inappropriate use, abuse, and adverse health outcomes. We will achieve this through three Aims: First, we will estimate the effects of a PA policy for long-acting opioids implemented in Oklahoma. Second, we will evaluate the impact of an opioid high dose limit implemented in Oregon. For both of these aims, we will employ a quasi-experimental approach to compare utilization and overdose-related outcomes to states without opioid policies. Finally, we will link Oregon Medicaid and prescription drug monitoring program (PDMP) data to assess the frequency and characteristics of patients who circumvent Medicaid policies by paying cash for opioids. Although this aim will be largely descriptive, it represents an innovative approach that will advance our understanding of the epidemiology of cash payments for opioids among those with prescription drug benefits. Knowledge gained from this project is relevant for state Medicaid programs for at least two reasons. First, Medicaid recipients are more likely to have substance abuse disorders and are disproportionately represented among overdose deaths. Second, in the upcoming years numerous high risk populations (e.g. recently incarcerated) will gain Medicaid coverage through the Affordable Care Act expansion. It is critical that policies which promote appropriate and safe opioid analgesic use are identified.