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Opioid crisis drives Medicaid policy

October 14, 2016
by Julie Miller, Editor in Chief
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In a survey released Thursday by the not-for-profit Kaiser Family Foundation (KFF), Medicaid officials identify a number of state-based efforts they are employing to address the opioid crisis currently as well as plans for the future. It’s an indicator of the scope of the issue nationwide.

For example, officials in 46 states say their fee-for-service (FFS) program had some type of prescription opioid quantity limit in place last year, while 22 indicated they adopted and/or expanded quantity-limit policies in 2016, and 30 say they have plans to do so in 2017. Other management strategies currently in place include prior authorization (45 states) and step therapy (32 states).

In March, the Centers for Disease Control and Prevention (CDC) released voluntary clinical guidelines for prescribers of opioid drugs for chronic pain. KFF asked state officials if their Medicaid programs have adopted or are planning to adopt these guidelines for managed care or for FFS models. Respondents in 21 states report adopting the guidelines or plans to adopt them in FFS programs next year. Not all states use managed care for Medicaid, but of the 39 that do, two report they already require managed care companies they work with to use the CDC guidelines, and nine report they will do so next year.

Additionally, KFF found that only 12 states had policies in place requiring prescribers to use prescription drug monitoring program (PDMPs) databases last year, with 10 states adopting or expanding their requirements this year. Eleven states have plans to require use of PDMPs next year.

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See the state-by-state KFF data here.