Policies requiring prior authorization for high-dose opioid prescriptions were found to be effective in reducing the average daily opioid dose consumed, according to a study published in the Journal of Pain.

De-identified MassHealth pharmacy claims data of patients who had ≥1 schedule 2 opioid pharmacy claim between 2002 and 2017 were examined. The policy implemented by Massachusetts Medicaid consisted of 3 interventions in which prescribing physicians were requested to obtain authorization before prescribing opioids at the following morphine equivalent doses (MED): intervention 1a: prospective prior authorization was required for fentanyl patch and oxycodone controlled release prescriptions with doses >360 mg; intervention 1b: expanded the prior authorization requirement from intervention 1a to morphine, methadone, meperidine, hydromorphone, levorphanol, and oxymorphone prescriptions; intervention 2 required prior authorization for any opioid prescription with a dose >240 mg MED; intervention 3 further reduced  the dose requirements for prior authorization to doses >120 mg MED for all opioid prescriptions. These interventions were implemented sequentially (intervention 1a, 2003; intervention 1b, 2004; intervention 2, 2014; intervention 3, 2016). The number of Medicaid members with any opioid use (ie, ≥1 opioid prescription) in the population of opioid users was reported for each quarter.  Changes in the natural log of the average daily MED were evaluated using segmented regression analysis.

A decrease in the natural log of the average daily MED was observed in the 6 quarters following intervention 1a implementation, (P <.001) immediately and in the 8 weeks following implementation of intervention 1b (P =.0002 and P =.023, respectively), and immediately after interventions 2 and 3 (P =.002 and P <.001, respectively). The percentage of opioid users who exceeded doses of 360 mg MED, 240 mg MED, and 120 mg MED decreased from baseline by 87.3%, 79.8%, and 75.2%, respectively.

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Study limitations include the lack of data on the use of opioid combinations and the sole inclusion of Medicaid members, which may limit the generalizability of the findings.

“This study contributes to options for policymakers and other Medicaid programs to consider as potential strategies to assist in addressing the opioid epidemic,” concluded the study authors.

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Garcia MM, Lenz K, Greenwood BC, et al. Impact of sequential opioid dose reduction interventions in a state Medicaid program between 2002 and 2017 [published online January 25, 2019]. J Pain. doi:10.1016/j.jpain.2019.01.008