Analysis of Opioid Prescription Practices After Mailed Intervention by a Pharmacy Benefit Manager to Prescribers of Commercial Health Plan Members
by Caitlin C. Albrecht, PharmD, Marleen K. Wickizer, PharmD, AE-C, CDCES, Agata Siwak, PharmD, Maria L. Hurst, CPhT, PMC, Robert V. Topp, PhD, RN
Objective: High-dose opioid prescriptions are associated with increased risk of opioid misuse and overdose. With access to members’ complete prescription claims histories, a pharmacy benefit manager (PBM) is in a unique position to intervene with members receiving high doses of opioids. This study investigates how a PBM-led intervention impacted members’ future opioid therapy.
Methods: Members were included if they had opioid claims averaging ≥90 morphine milligram equivalents (MME) per day from July 1, 2019, through October 31, 2019. Sixty-five members qualified for the study; 33 in the intervention group and 32 in the control group. In November 2019, letters containing information about the members’ opioid claims history were sent to prescribers of intervention group members. Outcomes were collected from July 1, 2020, through October 31, 2020. The primary outcome was mean decrease in daily MME; secondary outcomes included change in number of opioid prescribers.
Results: The average decrease in daily MME in the intervention group (33.3 ± 102.8) was not statistically different than the control group (13.4 ± 36.2, p = 0.30). The number of opioid prescribers was similar at baseline among the intervention (1.39 ± 0.14) and the control group members (1.63 ± 0.14) and statistically different following the intervention (1.18 ± 0.12 vs. 1.59 ± 0.12, p = 0.04).
Conclusions: Mailings to prescribers of members with high daily MME values were not found to be associated with a significant decrease in average daily MME but did result in a decrease in average number of opioid prescribers.
Keywords: Analgesics, Opioid, Pharmacists, Depression, Follow-Up Studies, Opioid-Related Disorders, Chronic Pain, Centers for Disease Control and Prevention, U.S., Prescriptions, Anxiety, Drug Interactions, Lifestyle, Pharmaceutical Preparations
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2023 September/October Table of Contents
Objective: High-dose opioid prescriptions are associated with increased risk of opioid misuse and overdose. With access to members’ complete prescription claims histories, a pharmacy benefit manager (PBM) is in a unique position to intervene with members receiving high doses of opioids. This study investigates how a PBM-led intervention impacted members’ future opioid therapy.
Methods: Members were included if they had opioid claims averaging ≥90 morphine milligram equivalents (MME) per day from July 1, 2019, through October 31, 2019. Sixty-five members qualified for the study; 33 in the intervention group and 32 in the control group. In November 2019, letters containing information about the members’ opioid claims history were sent to prescribers of intervention group members. Outcomes were collected from July 1, 2020, through October 31, 2020. The primary outcome was mean decrease in daily MME; secondary outcomes included change in number of opioid prescribers.
Results: The average decrease in daily MME in the intervention group (33.3 ± 102.8) was not statistically different than the control group (13.4 ± 36.2, p = 0.30). The number of opioid prescribers was similar at baseline among the intervention (1.39 ± 0.14) and the control group members (1.63 ± 0.14) and statistically different following the intervention (1.18 ± 0.12 vs. 1.59 ± 0.12, p = 0.04).
Conclusions: Mailings to prescribers of members with high daily MME values were not found to be associated with a significant decrease in average daily MME but did result in a decrease in average number of opioid prescribers.
Keywords: Analgesics, Opioid, Pharmacists, Depression, Follow-Up Studies, Opioid-Related Disorders, Chronic Pain, Centers for Disease Control and Prevention, U.S., Prescriptions, Anxiety, Drug Interactions, Lifestyle, Pharmaceutical Preparations
Download PDF
2023 September/October Table of Contents