Medicare Coverage Restrictions for Opioids Rose From '06 to '15
Formularies increasingly using quantity limits and prior authorization to restrict daily allowable dosing
TUESDAY, Oct. 10, 2017 (HealthDay News) -- In an effort to restrict daily allowable prescribed dosing of prescription opioids, Medicare Part D formularies increasingly used quantity limits and prior authorization from 2006 to 2015, according to a research report published online Oct. 9 in the Annals of Internal Medicine.
Elizabeth A. Samuels, M.D., M.P.H., from Yale University in New Haven, Connecticut, and colleagues used Centers for Medicare & Medicaid Services prescription drug plan formulary files to compare coverage in 2006, 2011, and 2015 for commonly used opioid medications except methadone.
The researchers found that more than two-thirds of drug-dosage combinations had no opioid prescribing restrictions in 2006 and 2011, while in 2015, about one-third had no restrictions. Step therapy was required by few formularies. There was an increase over time in the requirements for prior authorization (from a median of 0 percent in 2006 and 2011 to 4.4 percent in 2015). There was also an increase in the median proportion of drug-dose combinations with quantity limits from 8.9 percent in 2006 to 22.2 percent in 2011 and 71.1 percent in 2015. There was an increase in dose restrictions to less than 50 morphine milligram equivalents per day from a median of 2.2 percent of drug-dose combinations in 2006 to 4.4 and 13.3 percent in 2011 and 2015, respectively.
"Because formulary coverage directly affects prescribing, our study suggests that formularies present an underused opportunity to restrict opioid prescribing," the authors write.