Medicare places few restrictions on opioid prescribing | Behavioral Healthcare Executive Skip to content Skip to navigation

Medicare places few restrictions on opioid prescribing

October 16, 2017
by Tom Valentino, Senior Editor
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Although more restrictive than a decade ago, Medicare insurance plans still place few limits on opioid prescriptions, according to findings published in the Annals of Internal Medicine by researchers at Yale University.

The study’s authors reviewed prescription drug formularies from the Centers for Medicare and Medicaid Services from 2006, 2011 and 2015 for all opioid medications except methadone. Data from Medicare Advantage and Part D plans also was included.

One-third of opioid medications were prescribed with no restrictions, such as step therapy or prior authorization, according to the study. That is down from two-thirds of such drugs in 2006, but still a significant number, says Elizabeth Samuels, MD, MPH, the study’s lead author. Samuels says she was “pretty surprised that there was a significant proportion of prescription drugs that didn’t require any quantity limits or prior authorization,” given the field’s increased awareness of abuse potential with opioids.

“Early on, physicians thought it was not possible to become addicted to these medications,” Samuels says. “But by 2011 and definitely by 2015, we knew that was not the case.”

The study also found the number of opioids on the formulary list saw a slight increase from 2006 to 2015.

In a news release announcing their findings, the Yale researchers noted a previous study of a private insurer that saw a 15% decrease in opioid prescribing when restrictions, including prior authorization, quantity limits and provider-patient agreements, were implemented. Samuels says that while formularies can play a role in safe prescribing practices, it remains critical for behavioral healthcare providers to foster communication with patients while developing care plans to manage their pain.

“Formularies may encourage providers to explore or utilize opioid alternatives to pain, but ultimately, it comes down to the patient-provider interaction and use of other adjuvants when people are trying to manage pain, whether it be acute or chronic,” Samuels says. “Formulary restrictiveness is never going to be a substitute for that. It may encourage people to use those other non-opioid pain medication strategies, but ultimately it’s going to come down to the patient-provider interaction and care plan.”