States With Prescription Drug Monitoring Mandates Saw A Reduction In Opioids Prescribed To Medicaid Enrollees

Abstract

Prescription drug monitoring programs are promising tools to use in addressing the prescription opioid epidemic, yet prescribers' participation in these state-run programs remained low as of 2014. Statutory mandates for prescribers to register with their state's program, use it, or both are believed to be effective tools to realize the programs' full potential. Our analysis of aggregate Medicaid drug utilization data indicates that state mandates for prescriber registration or use adopted in 2011-14 were associated with a reduction of 9-10 percent in population-adjusted numbers of Schedule II opioid prescriptions received by Medicaid enrollees and amounts of Medicaid spending on these prescriptions. This effect was largely associated with mandates of registration, which were comprehensive in all adopting states, and not with mandates of use, which were largely limited in scope or strength before 2015. Our findings support the use of mandates of registration in prescription drug monitoring programs as an effective and relatively low-cost policy. Future research should further assess the value of strong mandates of use to ensure safer and more appropriate prescribing of opioids.

Keywords: Behavioral Health; Medicaid; Opioids; Prescription Drug Monitoring Programs.

Exhibit 1

Average predicted numbers of opioid prescriptions per 100 Medicaid enrollees per quarter in states with and without mandates for prescribers to register with or use the prescription drug monitoring program, 2011–14 Source/Notes: SOURCE Authors’ analysis of data for 2011–14 from the Medicaid State Drug Utilization Files. NOTES Schedule II opioids are the subclass of prescription opioids with the highest risk of abuse and dependence. Schedule III opioids have a lower potential for abuse and dependence than Schedule II opioids. As explained in the text, Alabama, Missouri, Pennsylvania, Utah, and the District of Columbia were excluded from the analysis. The error bars indicate 95% confidence intervals. **p < 0.05

Exhibit 2

Average predicted Medicaid spending on prescription opioids per 100 enrollees per quarter in states with and without mandates for prescribers to register with or use the prescription drug monitoring program, 2011–14 Source/Notes: SOURCE Authors’ analysis of data for 2011–14 from the Medicaid State Drug Utilization Files. NOTES Spending (in 2014 dollars) is before rebates paid by drug manufacturers. Schedule II and Schedule III opioids are explained in Exhibit 1 Notes. As explained in the text, Alabama, Missouri, Pennsylvania, Utah, and the District of Columbia were excluded from the analysis. The error bars indicate 95% confidence intervals. **p < 0.05

Exhibit 3

Average predicted numbers of prescriptions for Schedule II prescription opioids per 100 Medicaid enrollees per quarter in states with and without mandates for prescribers to register with and/or to use the prescription drug monitoring program, 2011–14 Source/Notes: SOURCE Authors’ analysis of data for 2011–14 from the Medicaid State Drug Utilization Files. NOTES Schedule II opioids are explained in the Exhibit 1 Notes. Mandates of registration require prescribers to register with the state’s monitoring program. Mandates of use require that prescribers use the program under certain circumstances, such as for a new prescription. Significance denotes the difference between a mandate policy category and no mandate. As explained in the text, Alabama, Missouri, Pennsylvania, Utah, and the District of Columbia were excluded from the analysis. The error bars indicate 95% confidence intervals. **p < 0.05.

Exhibit 4

Average predicted Medicaid spending on Schedule II prescription opioids per 100 enrollees per quarter in states with and without mandates for prescribers to register with and/or to use the prescription drug monitoring program, 2011–14 Source/Notes: SOURCE Authors’ analysis of data for 2011–2014 from the Medicaid State Drug Utilization Files. NOTES Spending (in 2014 dollars) is before rebates paid by drug manufacturers. Schedule II opioids are explained in the Exhibit 1 notes. Mandate policy categories are explained in the Exhibit 3 Notes. Significance denotes the difference between a mandate policy category and no mandate. As explained in the text, Alabama, Missouri, Pennsylvania, Utah, and the District of Columbia were excluded from the analysis. The error bars indicate 95% confidence intervals. **p < 0.05.