Restrictions on Opioid Prescribing Result in Outcomes Aligned with CDC Guidelines

Access to pain medications has led to the current opioid epidemic. A risk management program reconsidered utilization management to limit inappropriate opioid use and to encourage alignment with the Centers for Disease Control and Prevention (CDC) prescribing guidelines for opioids. This includes a set maximum days’ supply per fill of new prescriptions, restrictions on frequency of new fills and refills, and morphine equivalent dose (MED) limits depending on whether prescriptions were for new starts or current use.

Researchers evaluated the impact of utilization management strategies that were put into place by a large national pharmacy benefits manager. The results of the study were presented at the AMCP Annual Meeting during a poster session titled “Impact of Utilization Management Edits on Short-Acting Opioid Use and Prescribing Guideline Compliance.”

This pre–post analysis used pharmacy claims data for the two months preceding and five months following the July 1, 2017, implementation of this program. They included any claims for opioid medications during this time and compared clients who accepted the short-acting opioid utilization management edits and those who did not. The primary endpoints of the study were compliance with a 50 mg MED limit and fewer than seven days’ supply of opioids for members who were new to treatment, or a 90 mg MED limit for treatment-experienced members.

The analysis included 611,705 pharmacy claims for 6,122,592 members enrolled in plans that implemented these utilization management edits and 1,388,746 claims for 7,655,947 members that did not.

The odds of an opioid prescription for a new treatment member being within the CDC recommended 50 mg MED limit was higher for those who implemented utilization management edits (odds ratio [OR], 3.05; 95% CI, 2.99-3.11) than for those who were not (OR, 1.16; 95% CI 1.15-1.18). This was associated with 16.39% and 2.66%, respectively, improved compliance in each cohort. For new treatment members, the odds of an opioid prescription being within a seven days’ supply was higher for those in the utilization management edits cohort (OR, 1.29; 95% CI 1.26-1.31) than for those who were not (OR, 0.80; 95% CI 0.79-0.82). This was associated with a 3.37% improvement and 3.72% decrease, respectively, in compliance in each cohort.

Treatment-experienced members who were in the utilization management edits cohort were more likely to fill a prescription for less than 90 mg MED (OR, 1.74; 95% CI 1.69-1.80) than those who were not (OR, 1.08; 95% CI 1.06-1.10). This was associated with 3.23% and 0.47%, respectively, improved compliance in each cohort.

“Clients that implemented utilization management edits had a higher proportion of claims that were compliant with CDC guidelines than clients that did not enact [these],” the researchers concluded.

The study was sponsored by OptumRx.

Chiu C, Ursan I, Fensterheim L, Repp A, Calabrese D, Marks A. Impact of Utilization Management Edits on Short-Acting Opioid Use and Prescribing Guideline Compliance. Abstract F5. Presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting, April 23-26; Boston, MA.