In response to the opioid epidemic, public and private payers have implemented benefit limitations to reduce high-risk opioid prescriptions over the past several years. The effect of these policies on the increase of out-of-pocket payments is unclear. To understand this gap, a team that includes Comagine Health analysts and researchers compared discrepancies in trends between opioid prescription fills and pharmacy claims for 495,355 Medicaid beneficiaries using data from the Oregon Prescription Drug Monitoring Program (PDMP) and Oregon Medicaid administrative claims. They also assessed rates by morphine equivalent dose and co-prescribed opioids and benzodiazepines.
Comagine Health's Sanae El Ibrahimi, PhD, MPH, senior health care analyst; Sara Hallvik, MPH, senior director of advanced analytic services; and Gillian Leichtling, director of research and evaluation; coauthored a study recently published in the Pharmacoepidemiology and Drug Safety journal titled, “A comparison of trends in opioid dispensing patterns between Medicaid pharmacy claims and prescription drug monitoring program data.” The study, funded by grants from the Centers for Disease Control and Prevention and a National Institute on Drug Abuse, is the result of work with partners at Oregon Health & Science University (OHSU) and Oregon State University (OSU). The principal investigators were Esther Choo, MD, MPH, of the Center for Policy and Research in Emergency Medicine at OHSU and Daniel M. Hartung, PharmD, MPH, of the College of Pharmacy, OSU.
The team found higher rates of opioid prescription fills in the PDMP data than in Medicaid claims data. This suggests more Medicaid beneficiaries may be paying out-of-pocket for these fills. As many as 1 out of 5 opioid fills were not paid for by individuals' pharmacy benefit, possibly to circumvent opioid restrictions. Another concerning observation was the widening in the discrepancy between the opioid prescription fills and claims concurrent to when restrictive opioid policies were implemented.
“These results indicate a need to account for out-of-pocket payments and balance intended effects of policies with potential unintended effects that could limit progress or cause harm,” said El Ibrahimi.
“While we don't know that prescriptions were paid for with cash,” Hallvik added, "the increasing discrepancy between pharmacy claims and PDMP records is concerning and something that should be watched closely."