Rebecca B Naumann1, Stephen W Marshall2, Jennifer L Lund3, Nisha C Gottfredson4, Christopher L Ringwalt5, Asheley C Skinner6. 1. Injury Prevention Research Center and Department of Epidemiology, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB#7505, Chapel Hill, NC 27599, USA. Electronic address: RNaumann@unc.edu. 2. Injury Prevention Research Center and Department of Epidemiology, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB#7505, Chapel Hill, NC 27599, USA. Electronic address: SMarshall@unc.edu. 3. Department of Epidemiology, University of North Carolina at Chapel Hill, 2102D McGavran-Greenberg Hall, CB#7435, Chapel Hill, NC 27590, USA. Electronic address: Jennifer.Lund@unc.edu. 4. Department of Health Behavior, University of North Carolina at Chapel Hill, 319C Rosenau Hall, CB#7440, Chapel Hill, NC 27599, USA. Electronic address: gottfredson@unc.edu. 5. Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin St., CB#7505, Chapel Hill, NC 27599, USA. Electronic address: cringwal@email.unc.edu. 6. Duke Clinical Research Institute, 2400 Pratt St., Durham, NC 27705, USA. Electronic address: Asheley.Skinner@duke.edu.
Abstract
BACKGROUND: Insurance-based "lock-in" programs (LIPs) have become a popular strategy to address controlled substance (CS) (e.g., opioid) misuse. However, little is known about their impacts. We examined changes in CS dispensing to beneficiaries in the 12-month North Carolina Medicaid LIP. METHODS: We analyzed Medicaid claims linked to Prescription Drug Monitoring Program (PDMP) records for beneficiaries enrolled in the LIP between October 2010 and September 2012 (n=2702). Outcomes of interest were 1) number of dispensed CS prescriptions and 2) morphine milligram equivalents (MMEs) of dispensed opioids while a) locked-in and b) in the year following release. RESULTS: Compared to a period of stable CS dispensed prior to LIP enrollment, numbers of dispensed CS during lock-in and post-release were lower (count difference per person-month: -0.05 (95% CI: -0.11, 0.01); -0.23 (95% CI: -0.31, -0.15), respectively). However, beneficiaries' average daily MMEs of opioids were elevated during both lock-in and post-release (daily mean difference per person: 18.7 (95% CI: 13.9, 23.6); 11.1 (95% CI: 5.1, 17.1), respectively). Stratification by payer source revealed increases in using non-Medicaid (e.g., out-of-pocket) payment during lock-in that persisted following release. CONCLUSION: While the LIP reduced the number of CS dispensed, the program was also associated with increased acquisition of CS prescriptions using non-Medicaid payment. Moreover, beneficiaries acquired greater dosages of dispensed opioids from both Medicaid and non-Medicaid payment sources during lock-in and post-release. Refining LIPs to increase beneficiary access to substance use disorder screening and treatment services and provider use of PDMPs may address important unintended consequences.
BACKGROUND: Insurance-based "lock-in" programs (LIPs) have become a popular strategy to address controlled substance (CS) (e.g., opioid) misuse. However, little is known about their impacts. We examined changes in CS dispensing to beneficiaries in the 12-month North Carolina Medicaid LIP. METHODS: We analyzed Medicaid claims linked to Prescription Drug Monitoring Program (PDMP) records for beneficiaries enrolled in the LIP between October 2010 and September 2012 (n=2702). Outcomes of interest were 1) number of dispensed CS prescriptions and 2) morphine milligram equivalents (MMEs) of dispensed opioids while a) locked-in and b) in the year following release. RESULTS: Compared to a period of stable CS dispensed prior to LIP enrollment, numbers of dispensed CS during lock-in and post-release were lower (count difference per person-month: -0.05 (95% CI: -0.11, 0.01); -0.23 (95% CI: -0.31, -0.15), respectively). However, beneficiaries' average daily MMEs of opioids were elevated during both lock-in and post-release (daily mean difference per person: 18.7 (95% CI: 13.9, 23.6); 11.1 (95% CI: 5.1, 17.1), respectively). Stratification by payer source revealed increases in using non-Medicaid (e.g., out-of-pocket) payment during lock-in that persisted following release. CONCLUSION: While the LIP reduced the number of CS dispensed, the program was also associated with increased acquisition of CS prescriptions using non-Medicaid payment. Moreover, beneficiaries acquired greater dosages of dispensed opioids from both Medicaid and non-Medicaid payment sources during lock-in and post-release. Refining LIPs to increase beneficiary access to substance use disorder screening and treatment services and provider use of PDMPs may address important unintended consequences.
Authors: Rebecca B Naumann; Stephen W Marshall; Jennifer L Lund; Asheley C Skinner; Christopher Ringwalt; Nisha C Gottfredson Journal: N C Med J Date: 2019 May-Jun
Authors: Rebecca B Naumann; Kristin Shiue; Amin Mohamadi Hezaveh; Stephen W Marshall; Christopher R Cherry Journal: Am J Prev Med Date: 2019-12-19 Impact factor: 5.043
Authors: Tamara M Haegerich; Christopher M Jones; Pierre-Olivier Cote; Amber Robinson; Lindsey Ross Journal: Drug Alcohol Depend Date: 2019-09-19 Impact factor: 4.852