The Lock-In Loophole: Intended and Unintended Effects of Patient Review and Restriction Programs
Date & Time
Wednesday, April 4, 2018, 12:30 PM - 1:45 PM
Rebecca Naumann, PhD, MSPH, Epidemiologist, University of North Carolina at Chapel Hill
Andrew Roberts, PharmD, PhD, Assistant Professor of Preventive Medicine and Public Health, University of Kansas Medical Center
Moderator: Mary Colvin, CPA, CPCU, MBA, Chief Operating Officer, Kentucky Employers’ Mutual Insurance, and Member, Operation UNITE Board of Directors
CE Certified By: AMA,AAFP,ACPE,ANCC,NASW
Patient review and restriction programs, also known as lock-in programs (LIP), are proliferating across public and private payers to combat the opioid crisis. LIPs identify patients demonstrating potential overutilization of controlled substances and generally require patients to use a single prescriber and pharmacy. While widely implemented, there has been little research examining the complete impacts of LIPs.
In this session, presenters offer results from analyses evaluating the immediate and sustained effects of a state Medicaid LIP on a variety of healthcare utilization and health outcomes. Additionally, they discuss the extent of and reasons behind circumvention of the LIP, wherein patients obtain controlled substance prescriptions through out-of-pocket cash purchases. Data analyzed includes North Carolina Medicaid claims linked to records from the state's Prescription Drug Monitoring Program from October 2009 through June 2013, as well as qualitative interviews with North Carolina Medicaid LIP pharmacists. Findings from this work provide an important foundation for bolstering the design and operation of LIPs with an eye toward improving patient and public health outcomes.
UPON COMPLETION OF THIS COURSE, PARTICIPANTS WILL BE ABLE TO:
- Outline the effects of a Medicaid lock-in program on key utilization and health outcomes.
- Describe patterns and drivers of Rx opioid cash payments in a lock-in program patient population.
- Identify strategies for improving the design and public health benefit of lock-in programs moving forward.