Association of opioid fills with centers for disease control and prevention opioid guidelines and payer coverage policies: physician, insurance and geographic factors

Adeniyi T. Togun, Pinar Karaca Mandic, Rebecca Wurtz, Molly Moore Jeffery, Timothy Beebe

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background The Centers for Disease Control and Prevention (CDC) issued guidelines and certain healthcare payers have made pharmacy coverage changes (PCC) focusing on regulating prescription opioids. Aim We evaluated differences in the rate of first-time opioid fills at doses ≥ 50 morphine milligram equivalents (MME)/day and first-time opioid fills with benzodiazepine fill overlap following the CDC guidelines and following a PCC between provider types, geographic locations, and insurance types. Method We used OptumLabs® Data Warehouse claims data between 2014 and 2018. Subjects were opioid naïve non-cancer care patients, 18 years and older who had an identified chronic pain condition ICD diagnosis within 2 weeks prior to their first-time opioid fill. We used multiple treatment period segmented regression analysis with interaction terms to test the differences between primary care providers (PCPs) and specialist providers (SPs), urban and rural primary care service areas (PCSAs), and Medicare Advantage (MA) and commercially insured patients (CIPs) in their first-time opioid fill patterns. Results Prescribing first-time opioid fills at doses ≥ 50MME/day declined following the CDC guidelines and PCC, the decline was greater among SPs than PCPs and in rural PCSAs than urban PCSAs. Also, following the CDC guidelines, the decline was greater among MA patients however following the PCC the decline was greater among CIPs. There were no differences in rate of first-time opioid fill with benzodiazepine overlap between groups. Conclusion Responses to the CDC opioid guidelines and a PCC differed between PCPs and SPs, urban and rural PCSAs, and when prescribing to MA and CIPs. Understanding these differences is important to help inform future guidelines.

Original languageEnglish (US)
Pages (from-to)428-438
Number of pages11
JournalInternational Journal of Clinical Pharmacy
Volume44
Issue number2
DOIs
StatePublished - Apr 2022

Bibliographical note

Funding Information:
Jeannine Ouellette, MFA from the Minnesota Evidence-Based Practice Center is acknowledged for proofreading the manuscript. Dr. Itegbemie Obaitan (a gastroenterologist), Dr. Olusola Adegoke (a family physician) and coauthor-Dr Rebecca Wurtz (a family physician and associate professor) are acknowledged for their clinical input on validation and recommendation of chronic pain condition ICD codes used in the study. This research was funded by Agency for Healthcare Research and Quality (R01 HS025164) (PI: Karaca-Mandic)

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Keywords

  • CDC opioid guidelines
  • Insurance type and geography
  • Opioids
  • Payer coverage change
  • Provider specialty

PubMed: MeSH publication types

  • Journal Article

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