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. 2018 Sep;37(9):1509-1516.
doi: 10.1377/hlthaff.2018.0391.

A Health Plan's Formulary Led To Reduced Use Of Extended-Release Opioids But Did Not Lower Overall Opioid Use

Michael L Barnett  1 , Andrew R Olenski  2 , N Marcus Thygeson  3 , Denis Ishisaka  4 , Salina Wong  5 , Anupam B Jena  6 , Ateev Mehrotra  7
Affiliations

A Health Plan's Formulary Led To Reduced Use Of Extended-Release Opioids But Did Not Lower Overall Opioid Use

Michael L Barnett et al. Health Aff (Millwood). 2018 Sep.

Abstract

Many insurers are using formulary design to influence opioid prescribing, but it is unclear if these changes lead to reduced use or just substitution between opioids. We evaluated the effect of a new prior authorization process implemented in July 2015 for extended-release (ER) oxycodone by Blue Shield of California. Compared to other commercially insured Californians, among 880,000 Blue Shield enrollees, there was a 36 percent drop in monthly rates of ER opioid initiation relative to control-group members, driven entirely by decreases in ER oxycodone initiation and without any substitution toward other ER opioids. This reduction was offset by a 1.4 percent relative increase in the rate of short-acting opioid fills. There was no significant change in the overall use of any opioids prescribed, measured as morphine milligram equivalents. This suggests that though insurers can play a meaningful role in reducing the prescribing of high-risk ER opioids, a formulary change focused on ER opioids alone is insufficient to decrease total opioid prescribing.

Keywords: Managed Care - Quality < Managed Care; Pharmaceuticals; Public Health.

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Figures

Exhibit 2:
Exhibit 2:. Unadjusted Trends in New Extended Release Opioid Starts Relative to Implementation of Prior Authorization
Source: Authors’ analysis of Blue Shield of California and Truven MarketScan databases, 2014–2016. Notes: Unadjusted trends in monthly new extended release opioid fill rates per 10,000 persons divided into all ER opioids (right panel), oxycodone ER opioids (center panel) and non-oxycodone ER opioids (right panel). “New” prescribing is defined as a new fill among those without any opioid use in the prior 6 months. Trends are shown for the intervention population (Blue Shield of California, orange line) and the control population (MarketScan, blue line). The dashed black line indicates the time of oxycodone ER prior authorization implementation, July 2015. ER is extended release.
Exhibit 4:
Exhibit 4:. Unadjusted Trends in All Extended Release Opioid Starts Relative to Implementation of Prior Authorization
Source: Authors’ analysis of Blue Shield of California and Truven MarketScan databases, 2014–2016. Unadjusted trends in overall monthly ER opioid fill rates per 10,000 persons divided into all ER opioids (right panel), oxycodone ER opioids (center panel) and non-oxycodone ER opioids (right panel). Trends are shown for the intervention population (Blue Shield of California, orange line) and the control population (MarketScan, blue line). The dashed black line indicates the time of oxycodone ER prior authorization implementation, July 2015. ER is extended release.
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