Impact of Prescription Drug Monitoring Programs (PDMPs) on Opioid Utilization Among Medicare Beneficiaries in 10 U.S. States
Published in: Addiction, [Epub May 2017]. doi: 10.1111/add.13860
Posted on RAND.org on June 14, 2017
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- Did opioid use among Medicare beneficiaries change in the states studied after implementation of a prescription drug monitoring program?
- Was the change in use of opioids different in the two types of Part D programs, Medicare Advantage (MAPD) versus fee-for-service (PDP)?
Background and Aims
Prescription Drug Monitoring Programs (PDMPs) are a principal strategy used in the USA to address prescription drug abuse. We (1) compared opioid use pre- and post-PDMP implementation and (2) estimated differences of PDMP impact by reason for Medicare eligibility and plan type.
Analysis of opioid prescription claims in US states that implemented PDMPs relative to non-PDMP states during 2007–2012.
Florida, Louisiana, Nebraska, New Jersey, Vermont, Georgia, Wisconsin, Maryland, New Hampshire, and Arkansas, USA.
310,105 disabled and older adult Medicare enrolees.
Primary outcomes were monthly total opioid volume, mean daily morphine milligram equivalent (MME) dose per prescription, and number of opioid prescriptions dispensed. The key predictors were PDMP status and time. Tests for moderation examined PDMP impact by Medicare eligibility (disability versus age) and drug plan (privately-provided Medicare Advantage [MAPD] versus fee-for-service [PDP]).
Overall, PDMP implementation was associated with reduced opioid volume [2.36 kg/month, 95% Confidence Interval (CI)=-3.44, -1.28] and no changes in mean MMEs or opioid prescriptions twelve months after implementation compared with non-PDMP states. We found evidence of strong moderation effects. In PDMP states, estimated monthly opioid volumes decreased 1.67 kg (95% CI=-2.38, -0.96) and 0.75 kg (95% CI=-1.32, -0.18) among disabled and older adults, respectively, and 1.2 kg, regardless of plan type. MME reductions were 3.73 mg/prescription (95% CI=-6.22, -1.24) in disabled and 3.02mg/prescription (95% CI=-3.86, -2.18) in MAPD beneficiaries but there were no changes in older adults and PDP beneficiaries. Dispensed prescriptions increased 259/month (95% CI=39, 479) among the disabled and decreased 610/month (95% CI=-953, -257) among MAPD beneficiaries.
Prescription drug monitoring programs (PDMPs) are associated with reductions in opioid use, measured by volume, among disabled and older adult Medicare beneficiaries in the USA compared with states that do not have PDMPs. PDMP impact on daily doses and daily prescriptions varied by reason for eligibility and plan type. These findings cannot be generalized beyond the 10 US states studied.
- Prescription drug monitoring programs in ten states were associated with reductions in total volume of opioids, but no effect on number of opioid prescriptions dispensed was observed.
- The decline in opioid volume without a decline in number of prescriptions suggests that downward shifts did occur in the potency or type of opioid prescribed, the drug strength, and/or the number of days supplied.
- Medicare beneficiaries eligible because of age experienced less reduction in total opioid volume than those eligible because of disability.
- Reductions in opioid use were greater among beneficiaries in MAPD plans than those in PDP plans, and the magnitude of the effect varied among states.
- Generalizations about these findings should not be made for states that were not part of this study.