The effect of targeted insurer–mandated prescription monitoring on opioid prescribing patterns

Abstract

ObjectivesThe purpose of this study was to determine the impact of a mandate from 2 large insurers in South Carolina for mandatory review of the state’s prescription drug monitoring program (PDMP) for controlled substance (CS) prescriptions for more than 5 days’ supply on the proportion of opioid prescriptions for less than or equal to 5 days in a statewide adult population. In addition, changes in the mean morphine milligram equivalents (MME) per day for prescriptions for 5 days or less were described to evaluate prescribing changes. Design, setting and participantsAll prescriptions for opioids written for and filled by adults (≥ 18 years of age) and reported to the PDMP from January 1, 2010, to December 31, 2017, were included in an interrupted time series analysis. Outcome measuresAn interrupted time series analysis was performed to determine if there was a significant change in the proportion of opioid prescriptions for less than or equal to 5 days’ supply. ResultsOverall opioid prescriptions decreased over the time period by 11.5%, including a decreasing rate of opioid prescriptions for less than or equal to 5 days’ supply. There was no statistical difference in the slope between the pre- and postmandate cohorts (P = 0.077, r2 = 0.951). There was not an identified corresponding increase in the MME per day of prescriptions. ConclusionOur analysis found that 2 major insurer mandates that occurred in South Carolina in 2016, which required a review of the state PDMP for CS prescriptions for more than 5 days’ supply, did not have a significant impact on the proportion of opioid prescriptions for less than or equal to 5 days’ supply in the statewide population. In addition, we did not find any concern that prescribers attempted to circumvent the requirement by inappropriately adjusting dosing instructions.