Opioid Management Program Helped Cut Misuse Among Medicaid Enrollees

According to a poster presentation at AMCP Nexus 2017, a managed care pharmacy program tailored to Medicaid members helped to cut opioid utilization.

The researchers explained that Amida Care—the study population’s health plan—is a Medicaid Special Needs Health Plan for a complex patient population in New York City that previously had not implemented opioid restrictions. 

“Historically, Amida Care had no restrictions or utilization management parameters in place for members receiving opioids,” Elly Fatehi, PharmD, MPH, director of pharmacy at Amida Care, wrote in her presentation. “Thus, our opioid utilization closely reflected the high utilization trends of the United States opioid epidemic.”

As a result the researchers developed an opioid management program aimed at bring utilization rates down among this patient population with the goal of reducing misuse.

“In order to ensure safe and appropriate opioid utilization and mitigate the use of high doses, we developed a multi-phasic Chronic Opioid Program to address opioid use in non-cancer patients,” Dr Fatehi and colleagues wrote. 

In order to evaluate the impact of the opioid utilization management program on overall opioid utilization,  the researchers conducted a observational retrospective evaluation of the interventions developed within the program. They measured utilization among members who were high users before implementation of interventions.

Study results showed that compared to 3 months before the study’s initiation, the proportion of opioid utilizers at 3 months after the study began decreased by 10%. Furthermore, the interventions reduced the overall daily dose used by plan members by 40%. 

“This analysis demonstrates that a managed care pharmacy driven initiative including formulary restrictions can decrease opioid utilization and potentially mitigate the misuse and abuse of prescription opioids,” Dr Fatehi and colleagues concluded.

—David Costill